shukoor65/lab-rag-model huggingface dataset:
Diagnostic imaging of heterotopic ossification with coexistent deep-venous thrombosis in flaccid paraplegia. Heterotopic ossification and deep-venous thrombosis can coexist. This raises potential problems because diagnosis depends heavily on imaging studies, and an ideal imaging study which will cost-effectively and noninvasively diagnose both conditions simultaneously is not readily available. A case of coexistent heterotopic ossification and deep-venous thrombosis in flaccid paraplegia is presented. In this case, deep-venous thrombosis and pulmonary embolus were diagnosed and treatment was begun without knowledge of the coexistent heterotopic ossification. Alternative imaging and laboratory diagnostic strategies are discussed. It was concluded that, at this time, clinical acumen and judicious use of traditional diagnostic alternatives is the best means of selecting appropriate treatment. Awareness of the coexistence of the two conditions are careful attention to the patient's clinical course can minimize treatment delays and resultant morbidity.
Evaluation of the patient with stable angina following coronary artery bypass surgery. Bypass graft stenosis and occlusion are relatively common events, occurring eventually in the majority of patients who survive beyond 5 years after coronary artery bypass graft surgery. These processes, in combination with progressive native coronary artery disease, lead to recurrent angina and an increased need for medication in most patients late after surgery. Patients with unstable ischemic symptoms generally should proceed directly to coronary arteriography, whereas patients with stable angina may be candidates for noninvasive testing to evaluate their risk and the extent of myocardial jeopardy. If the initial revascularization procedure is successful, preoperative thallium 201 imaging abnormalities should be reversed. Persistent abnormalities beyond 6 months after revascularization indicate incomplete revascularization or perioperative infarction. Defects noted in the immediate postoperative period may be areas of myocardial stunning or hibernation, which can require up to 6 months to reverse. If chest pain recurs after revascularization, a normal thallium 201 perfusion pattern indicates that the symptom is probably not ischemic in nature. Thallium 201 perfusion abnormalities may precede symptoms by several months and may be the only indication of significant myocardial ischemia in patients with silent ischemia. Advanced tomographic imaging techniques, such as single photon emission computed tomography (SPECT), should theoretically improve disease detection and localization following revascularization. Practically speaking, only the left anterior descending coronary bed is well evaluated by these tomographic imaging techniques. The sensitivity and specificity of SPECT imaging for evaluation of posterior circulation abnormalities remains unacceptably low. Complexities of competitive flow and collateralization that may exist in the postoperative period make it difficult to relate perfusion abnormalities to a specific graft stenosis. However, tomographic perfusion imaging may provide useful correlative information on the functional impact of bypass graft stenoses in patients with recurrent angina who have undergone coronary angiography and in whom the angiographic indications for repeat surgery or angioplasty are not compelling. Newer tomographic and metabolic imaging techniques such as CT, NMRI, and PET remain unproven as diagnostic tests for the evaluation of unselected patient populations presenting with recurrent angina following revascularization surgery.
Changes in alpha-1 and beta-2 adrenoceptor density in human hepatocellular carcinoma. Catecholamines are involved critically in the mechanisms of liver cell proliferation by acting on hepatic alpha-1 and beta-2 adrenoceptors. To identify the role of these receptors in human hepatocellular carcinoma (HCC), the density was examined of alpha-1 and beta-2 adrenoceptors with their affinity and coupling of beta-2 adrenoceptors to adenylate cyclase in HCC tissue and in nonadjacent/nontumor tissue from the same livers. Studies were also done on healthy livers from age-matched and sex-matched patients undergoing abdominal surgery for nonhepatic diseases. Twenty-two HCC had a decrease of about 72% in alpha-1 adrenoceptor density compared with their nonadjacent/nontumor tissue and a decrease of about 40% compared with healthy controls. Nonadjacent/nontumor tissue from HCC patients had a 125% increase in alpha-1 adrenoceptor density compared with healthy livers. Twenty-three of 24 HCC had an increase of about 180% in beta adrenoceptor density compared with their nonadjacent/nontumor tissue and healthy controls. Beta adrenoceptors were coupled to adenylate cyclase, as evidenced by a guanosine triphosphate-mediated right shift in (-)-isoproterenol competition isotherms and by cyclic adenosine monophosphate (cAMP) production after stimulation with (-)-isoproterenol. The HCC tissue yielded a larger increase in cAMP than nonadjacent/nontumor tissue and healthy controls. The authors conclude that a higher density of alpha-1 adrenoceptors in nonadjacent/nontumor tissue from HCC characterizes the "healthy" part of the liver in HCC patients and that an increase in beta-2 and a decrease in alpha-1 adrenoceptor densities characterize the tumor part of the liver in human HCC.
High-affinity androgen binding and androgenic regulation of alpha 1(I)-procollagen and transforming growth factor-beta steady state messenger ribonucleic acid levels in human osteoblast-like osteosarcoma cells. Clinical observations have demonstrated a positive effect of estrogens and androgens on the maintenance of structural bone integrity. This study examines the direct effects of androgenic hormones on the osteoblast-like human osteosarcoma cell line, HOS TE85. Employing radiolabeled dihydrotestosterone (DHT), 2800 saturable, high-affinity (dissociation constant = 0.66 nM) androgen binding sites were detected per HOS TE85 cell. Androgen binding was specific in that DHT and testosterone (T) displayed significantly greater competition than the progestins, progesterone and medroxyprogesterone. The expression of androgen receptors in HOS TE85 cells was further substantiated by Northern analysis. A human androgen receptor complementary DNA probe revealed a 9.5 kilobase transcript which corresponds to the predominant human androgen receptor transcript detected in human male reproductive tissues. Androgens were also found to elicit biological responses in HOS TE85 cells. Physiological concentrations of DHT and T decreased HOS TE85 cell proliferation as assessed by cell count. This finding suggests that DHT may also play a role in osteoblast differentiation. In support of this hypothesis, treatment with T (24 h, 10 nM) enhanced the abundance of both alpha 1(I)-procollagen messenger RNA (mRNA) (5-fold) and transforming growth factor-beta mRNA (2.2 fold). The nonaromatizable androgen DHT (24 h, 10 nM) elicited an increase in the steady state concentration of alpha 1(I)-procollagen mRNA similar to the increase observed with T treatment. Thus, in addition to the recent discovery of estradiol receptors and estrogenic regulation of HOS TE85 cells, it is now evident that these osteoblast-like osteosarcoma cells also express high affinity androgen binding sites and can respond biologically to androgens.
Membranous lipodystrophy: MR imaging appearance of the brain. Five patients with membranous lipodystrophy (lipomembranous polycystic osteodysplasia with progressive dementia) underwent magnetic resonance (MR) imaging of the brain. T2-weighted MR images showed atrophied cerebral white matter with dilated ventricles; increased signal intensity of the white matter; and decreased signal intensity of the thalamus, putamen, caudate nucleus, and cerebral cortex. Although each single finding is not specific, the combination of the above MR findings when coupled with skeletal lesions strongly suggests this rare disease.
Factors affecting the patency of stents in malignant biliary obstructive disease: univariate and multivariate analysis. To investigate the factors affecting the patency of biliary stents, we performed univariate and multivariate analyses in 370 straight stents with diameters of 10- to 12-French gauge which had been inserted singly as palliative treatment in 228 patients with malignant biliary obstructive disease. In the analysis of 226 first stents, advanced age of patients and higher serum bilirubin levels before insertion were found to be significant unfavorable factors limiting the duration of stent function. Overall, older age, male sex, no stent cleaning, and insertion on three or more occasions were significant unfavorable prognostic factors for patency. The risk of occlusion for stents inserted on three or more occasions was 2.32 times that of the first stent insertion. The median duration of patency of first, second, and subsequent stents was 177, 98, and 97 days, respectively. Diagnosis and the area of stenosis were unrelated to patency. No predictive significance of length or size of stent between 10- and 12-French gauge was found in our study.
Failure of ciprofloxacin to eradicate convalescent fecal excretion after acute salmonellosis: experience during an outbreak in health care workers. OBJECTIVE: To determine the efficacy of ciprofloxacin therapy in eradicating convalescent fecal excretion of salmonellae after acute salmonellosis. DESIGN: Randomized, placebo-controlled, double-blind trial of ciprofloxacin, with prospective follow-up of nonparticipants. SETTING: An acute care community hospital experiencing an outbreak of salmonellosis. PATIENTS: Twenty-eight health care workers developed acute infection with Salmonella java; 15 participated in a placebo-controlled trial of ciprofloxacin, beginning on day 9 after infection. INTERVENTIONS: Eight patients were randomly assigned to receive ciprofloxacin, 750 mg, and 7 patients to receive placebo; both were administered orally twice daily for 14 days. Nonparticipants who received therapy were placed on the same ciprofloxacin regimen. MEASUREMENTS AND MAIN RESULTS: Study participants had follow-up stool cultures every 3 days initially and then weekly for 3 weeks; nonparticipants were followed until three consecutive cultures were negative. All eight ciprofloxacin recipients showed eradication of S. java from stool cultures within 7 days of beginning therapy (compared with 1 of 7 placebo recipients), and their stool cultures remained negative up to 14 days after discontinuing therapy (P less than 0.01). However, 4 of 8 relapsed; their stool cultures became positive between 14 and 21 days after therapy. In addition, 3 of 3 hospitalized patients treated with ciprofloxacin who did not participate in the controlled trial also relapsed. Thus, the total relapse rate was 7 of 11 (64%; 95% CI, 31% to 89%). In 4 of these 7 patients, relapse was associated with a longer duration of fecal excretion of salmonellae than that of the placebo group. Relapse could not be explained on the basis of noncompliance, development of resistance, or presence of biliary disease. CONCLUSIONS: Despite its excellent antimicrobial activity against salmonellae and its favorable pharmacokinetic profile, ciprofloxacin at a dosage of 750 mg orally twice daily had an unacceptably high failure rate in patients with acute salmonellosis and may have prolonged fecal excretion of salmonellae. The late occurrence of relapses indicates the need to obtain stool cultures up to 21 days after therapy to document fecal eradication in acute salmonellosis.
Insulin secretory response to secretagogues by perifused islets from chronically glucose-infused rats. Perifused islets from rats infused for 7 days with 40% glucose exhibited an altered secretory response to selected stimuli. Both phases of insulin release were blunted when 20 mM L-leucine was tested; the secretory response to a subsequent leucine stimulation was also blunted compared with the control group. The ability of 20 mM alpha-ketoisocaproate to stimulate the release of insulin was also greatly diminished in islets from glucose-infused rats. The secretory response to 50 microM tolbutamide plus 7 mM glucose by perifused islets from glucose-infused rats was 45% lower than in the control group. In addition, the response to a subsequent 10 mM glucose stimulation was lost. On the other hand, islets from glucose-infused rats responded to 20 microM forskolin plus 16.7 mM glucose with on significant change in the amount of insulin released during both phases of stimulation compared with the control group. The response to 100 nM phorbol 12-myristate 13-acetate was 3.1-fold higher in islets from glucose-infused compared with saline-infused rats. The finding that chronic infusions of glucose lead to selective impairment of the secretory response to fuel stimuli and agents such as tolbutamide that act on metabolically regulated K+ channels gives support to the notion that alterations in the generation of metabolic coupling signals might be involved in the phenomenon described here.
Patency rate of endoscopic middle meatus antrostomy. A series of 145 patients with chronic sinusitis were treated with functional endoscopic sinus surgery. Patency of the middle meatus was evaluated by actuarial life-table methods. After 24 months' follow-up, the overall patency rate of endoscopic middle meatotomy was 94.08%. Questionnaire data indicated that 91.8% of these patients were improved or asymptomatic. This preliminary study indicates that the patency rate of middle meatal antrostomy appears to be greater than that of inferior meatal antrostomy when compared to literature controls, and that a high percentage of these patients are improved by this surgery.
Intracellular pH in human resistance arteries in essential hypertension. To investigate intracellular pH (pHi) in human resistance arteries in essential hypertension, vessels were obtained from small biopsies of skin and subcutaneous fat from 14 untreated patients, and the results were compared with those from 14 matched normotensive control volunteers. Segments of isolated resistance arteries were mounted in a myograph and loaded with the pH-sensitive fluorescent dye 2',7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein. Fluorescence signals were monitored using a series of barrier filters and chromatic beam splitters. In this way both resting pHi and the changes in pHi observed during isometric contractions initiated by agonists could be recorded. Resting pHi was not different in vessels from hypertensive patients (hypertensive, 7.24 +/- 0.06 versus control, 7.25 +/- 0.04 pH units). The application of ethylisopropylamiloride (EIPA) and 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS) demonstrated that both Na(+)-H+ exchange and bicarbonate-dependent membrane mechanisms contributed to pHi homeostasis but that neither system was overactive in hypertension (pHi change with EIPA in vessels from hypertensive versus control subjects was -0.11 +/- 0.02 and 0.13 +/- 0.03 pH units, respectively, and pHi change with DIDS in vessels from hypertensive versus control subjects was -0.097 +/- 0.05 and -0.091 +/- 0.03 pH units, respectively). The application of norepinephrine or 125 mM K+ solution induced contraction in the arterial segments with an accompanying fall in pHi. With norepinephrine this fall was significantly attenuated in vessels from hypertensive patients. These results fail to provide evidence for raised pHi in resistance arteries in human essential hypertension, and contrary to previous reports in circulating blood cells, Na(+)-H+ exchange is not overactive in the vessels of such patients.
Cerebrovascular abnormalities in pediatric stroke: assessment using parenchymal and angiographic magnetic resonance imaging. Three-dimensional (volume) magnetic resonance angiography is a noninvasive technique that images the intracranial and cervical arterial vasculature without contrast agents. Twenty-four children with strokes had combined parenchymal magnetic resonance imaging and magnetic resonance angiography 1 day to 4 years after acute presentation. Eight had had prior intra-arterial angiography. Eighteen magnetic resonance angiographic studies showed arterial stenosis or occlusion in the vascular distribution of magnetic resonance image-defined brain infarction and, in 7 children, in the same location as previously defined abnormalities on intra-arterial angiography. One child had a normal intra-arterial angiogram and magnetic resonance angiogram. The other 5 children with normal magnetic resonance angiographic studies included 3 with presumed embolic disease, 1 with meningitis, and 1 with Crohn's disease-related vasculitis. Collateral flow patterns could be determined in 4 children. Artifact presenting as filling defects in vessels was present in 10 studies, but did not interfere with interpretation of 8 studies. Combined magnetic resonance imaging/magnetic resonance angiography provides a screening technique to evaluate noninvasively brain parenchyma and vasculature in children with suspected large-vessel abnormalities, allowing selection for intra-arterial angiography and serial monitoring of vascular abnormalities over time and during therapeutic intervention.
Scintigraphic measurement of regional gut transit in idiopathic constipation. In this study, total gut transit and regional colonic transit in patients with idiopathic constipation were measured scintigraphically. Eight patients with severe constipation were studied, none of whom had evidence of abnormal function of the pelvic floor. 99mTc-radiolabeled Amberlite resin particles (average diameter, 1 mm; Sigma Chemical Co., St. Louis, MO) with a mixed meal were used to assess gastric emptying and small bowel transit; similar particles labeled with 111In were ingested in a coated capsule that dispersed in the ileocecal region. These were used to quantify colonic transit. Five healthy volunteers were also studied. Two patients showed delayed gastric emptying and two had slow small bowel transit. Seven of the eight patients had slow colonic transit. In five, delay affected the whole colon ("pancolonic inertia"); in two, transit in the ascending and transverse colon was normal, but solids moved through the left colon slowly. Mean colonic transit was also measured using radiopaque markers; this technique identified the patients with slow transit, as shown by measurements of overall colonic transit by simultaneous scintigraphy. However, estimated transit through the ascending and transverse colons was considerably shorter by the radiopaque marker technique. In conclusion, idiopathic constipation is characterized by either exaggerated reservoir functions of the ascending and transverse colons and/or impairment of propulsive function in the descending colon. Particle size may influence the result of regional colonic transit tests. Transit delays in other parts of the gut suggest that, in some patients, the condition may be a more generalized motor dysfunction.
Pain causes in 200 patients referred to a multidisciplinary cancer pain clinic. Causes of pain were analysed in 200 patients referred to a specialized cancer pain clinic. Pain caused by tumour growth was found in 158 patients, pain secondary to cancer or its treatment in 116 patients and pain unrelated to cancer in 33 patients. Visceral involvement (74 cases), bone metastases (68 cases), soft tissue invasion (56 cases) and nerve/plexus pressure or infiltration (39 cases) were the most frequent causes of pain due to tumour growth. Myogenic pain (68 cases) was the most frequent cause of secondary pain. The patients presented with a multitude of different combinations of causes of pain, the majority having at least two separate causes. Since pain treatment in cancer patients should be determined by its aetiology, a detailed analysis of the pain condition in each patient should form the basis for a rational therapy.
The effects of induced mood on laboratory pain. Sixty-five subjects experienced 2 cold pressor immersions. Following the initial immersion, subjects participated in the Velten mood induction procedure by reading either depressive, neutral or elative statements. The sensory discriminative response to pain was measured by ratings of pain, and the affective-reactive response to pain was measured by pain tolerance. Pain tolerance, but not pain ratings, were affected by mood inductions with subjects in the depression condition shortening their tolerance times more than the subjects in the neutral condition and the subjects in the elative condition increasing their tolerance times.
Anatomic location and variety of nonmalignant neck masses seen in surgical practice. During a 10-year interval, 189 patients, comprised of 121 females and 68 males ranging in age from 1 to 98 years, were surgically treated for nonmalignant neck masses. Nonmalignant neck masses were located in the thyroid or submaxillary gland in 60 per cent of these patients. Thyroid adenoma, reactive cervical nodes, and mixed tumor of the submaxillary salivary glands represented the three most commonly occurring nonmalignant pathologic conditions in this series. When stratified by age and sex, thyroid abnormalities, specifically thyroid adenoma, occurred most often in females of all ages. In males, reactive nodes were usually seen before 40 years of age; thereafter, tumors of the submaxillary salivary gland predominated. Most studies of nonmalignant neck masses indicate that reactive nodes are the most common condition in patients of all ages. Thyroid conditions were seen most frequently in this group of patients. The probable explanation is a tertiary referral pattern to surgeons. Patients with nonsurgical conditions were, presumably, identified and managed earlier and not referred further, and therefore did not appear in this group of patients.
Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. BACKGROUND. We performed a prospective, randomized study in patients with previously untreated advanced (Stage III or IV) laryngeal squamous carcinoma to compare the results of induction chemotherapy followed by definitive radiation therapy with those of conventional laryngectomy and postoperative radiation. METHODS. Three hundred thirty-two patients were randomly assigned to receive either three cycles of chemotherapy (cisplatin and fluorouracil) and radiation therapy or surgery and radiation therapy. The clinical tumor response was assessed after two cycles of chemotherapy, and patients with a response received a third cycle followed by definitive radiation therapy (6600 to 7600 cGy). Patients in whom ther was no tumor response or who had locally recurrent cancers after chemotherapy and radiation therapy underwent salvage laryngectomy. RESULTS. After two cycles of chemotherapy, the clinical tumor response was complete in 31 percent of the patients and partial in 54 percent. After a median follow-up of 33 months, the estimated 2-year survival was 68 percent (95 percent confidence interval, 60 to 76 percent) for both treatment groups (P = 0.9846). Patterns of recurrence differed significantly between the two groups, with more local recurrences (P = 0.0005) and fewer distant metastases (P = 0.016) in the chemotherapy group than in the surgery group. A total of 59 patients in the chemotherapy group (36 percent) required total laryngectomy. The larynx was preserved in 64 percent of the patients overall and 64 percent of the patients who were alive and free of disease. CONCLUSIONS. These preliminary results suggest a new role for chemotherapy in patients with advanced laryngeal cancer and indicate that a treatment strategy involving induction chemotherapy and definitive radiation therapy can be effective in preserving the larynx in a high percentage of patients, without compromising overall survival.