shukoor65/lab-rag-model huggingface dataset:
Diuretic agents versus beta-blockers. Comparison of effects on mortality, stroke, and coronary events. Three recently concluded large randomized clinical trials have compared the preventive effects of diuretic agents and beta-blockers in the treatment of approximately 22,000 subjects with hypertension. In the Medical Research Council trial, bendrofluazide (10 mg daily) was compared with a dose of propranolol (as much as 240 mg daily), a nonselective beta-blocker without intrinsic sympathomimetic activity. Two selective beta-blockers, atenolol (100 mg daily) and metoprolol (200 mg daily), were compared with bendrofluazide (5-10 mg daily) and hydrochlorothiazide (50-100 mg daily) in the Heart Attack Primary Prevention in Hypertension trial. In the International Prospective Primary Prevention Study in Hypertension, 160 mg of slow-release oxprenolol, a beta-blocker with intrinsic sympathomimetic activity, was compared with a diuretic-based regimen not containing beta-blockers. In each trial, similar reductions in mean diastolic blood pressure were achieved with diuretic and beta-blocker treatment that lasted for several years. All-cause mortality and fatal and nonfatal stroke and coronary event rates were also similar in the treatment groups. Thus, it appears that beta-blockers are as effective as diuretic agents in improving survival and in preventing major morbid events. Regarding cigarette smoking and stroke incidence, observations based on post hoc subgroup analyses of the Medical Research Council trial were not supported by subgroup findings in the Heart Attack Primary Prevention in Hypertension and the International Prospective Primary Prevention Study in Hypertension trials, and these observations should not form the basis for any treatment recommendations.
Visceral fat accumulation: the missing link between psychosocial factors and cardiovascular disease? Neuroendocrine responses to psychosocial pressures have been well characterized. The defence reaction is followed by increased activity of the sympathetic nervous system. Essential hypertension might be induced by such mechanisms. The defeat reaction is characterized by increased activity along the corticotropin releasing factor-adrenocorticotropin hormone-cortisol axis, resulting in the inhibition of gonadotropin secretion. Such endocrine disturbances are followed by metabolic aberrations, and probably also by the accumulation of visceral fat. Subjects with abdominal fat accumulation (high waist/hip circumference ratio, WHR) have recently been found to exhibit a number of psychosocial handicaps, together with endocrine aberrations characteristic of the defence and, in particular, the defeat reaction, as well as the associated circulatory and metabolic aberrations. Such abnormalities, including the WHR itself, are established risk factors for cardiovascular disease and diabetes. It is postulated that increased WHR is a symptom of chronic hypothalamic arousal as a result of a defeat reaction to psychosocial pressures. This might lead to the development of disease via circulatory and metabolic derangements.
Dynamic F waves in neurogenic claudication. Serial F waves were elicited before and after ambulation in 2 patients with neurogenic claudication. In both patients dynamic changes in F wave parameters consisting of either unelicitability or increased latencies occurred postexercise. The time course of these changes and their subsequent rapid reversibility over 15 minutes suggest ischemic-induced conduction block and slowing in proximal motor axons. These physiological changes may account for some of the dynamic neurological symptoms of this disorder. Moreover, F wave exercise testing may provide corroborative information for the diagnosis of neurogenic claudication.
Thromboembolism in patients with advanced mitral valve prolapse Thromboembolism in mitral valve prolapse (MVP) has been suggested to occur in relation to valvular cul-de-sac recesses and endothelial wear-and-tear denudations. Such pathology would be suspected to be prominent in advanced cases of MVP necessitating open-heart operation. We therefore analysed the prevalence of perivalvular thrombi and episodes of systemic arterial embolism (SE) prior to operation in 21 consecutive patients with MVP and severe valve regurgitation. No perivalvular or left atrial thrombi were found during open-heart surgery, but three of the patients (14%, 3-36% with 95% confidence limits) experienced SE, in one case despite long-term anticoagulation. All cases of SE took place less than 3 months before operation. The results indicate that persistent thrombi are rare in MVP and severe valve regurgitation. However, such patients run a substantial risk of SE when they reach a clinical and haemodynamic stage that makes valve surgery mandatory.
Comparison of serial quantitative evaluation of calcified coronary artery plaque by ultrafast computed tomography in persons with and without obstructive coronary artery disease. Coronary artery calcium indicates atherosclerosis. Ultrafast computed tomography (CT) can noninvasively visualize and quantify coronary calcium, permitting the natural history of calcified plaque to be studied. This pilot study evaluates the ability of ultrafast CT to follow the progression of calcified plaque within the coronary arteries in patients with and without obstructive coronary artery disease (CAD). Twenty-five subjects had serial ultrafast CT scans of the coronary arteries a mean of 406 days apart. Changes in the number of calcific deposits, calcified plaque area and volume, calcium density and total calcium score were measured. In the 20 patients with calcium on the first study, there were statistically significant increases in mean peak CT number, total calcified plaque volume, total calcified plaque area and total calcium score (p less than 0.0001 for all). Subjects with proved obstructive CAD (n = 10) on angiography had a 48% increase in calcified plaque volume compared with 22% in asymptomatic subjects (n = 10). Comparison of serial studies showed that smaller calcific deposits often coalesced into single larger calcific deposits. Ninety-eight percent (235 of 241) of deposits identified on the first study were accounted for on the second study. Patients with obstructive CAD had a higher number of new calcific deposits than did those in the asymptomatic group (55 vs 18, p = 0.058). Serial ultrafast CT accurately tracks the progression of coronary artery calcium. It is a useful technique for assessing changes in calcified plaque formation in both asymptomatic subjects and in patients with obstructive CAD. It may be useful for studying the natural history of CAD and the effects of intervention on the course of CAD.
Arthritis and nephritis in patients with systemic lupus erythematosus. Previous publications suggest that in patients with systemic lupus erythematosus (SLE), rheumatoid factor (RF) may be "protective" against nephritis. In our study of 662 patients with SLE, we found that persistent, rheumatoid-like arthritis showed a much stronger inverse correlation with nephritis than RF. Of 186 such patients, 59 developed clinically evident nephritis (32%) compared to 263 of the other 476 patients (55%) (p less than 10(-7). RF showed only a weak inverse relationship to nephritis (p = 0.064). We conclude that the presence of persistent rheumatoid-like arthritis in patients with SLE identifies a clinical subset of patients who are less likely to develop nephritis than those with no arthralgia, no objective arthritis or only episodic arthritis. We hypothesize that such patients represent a genetically determined subset among patients with SLE and that perhaps they are more likely to bear the HLA-DR4 allele.
Repair of inferior iridodialysis using a partial-thickness scleral flap. We present a technique of inferior iridodialysis repair using a partial-thickness scleral flap, which, in turn, employs a modification of the technique currently used to suture posterior chamber intraocular lenses under scleral flaps.
Fluconazole therapy for chronic disseminated candidiasis in patients with leukemia and prior amphotericin B therapy. OBJECTIVE: To study the efficacy of fluconazole against chronic disseminated candidiasis (hepatosplenic candidiasis) in patients with leukemia in whom amphotericin B treatment had failed. DESIGN: Retrospective analysis of patients with chronic disseminated candidiasis treated with fluconazole on a compassionate investigational new drug protocol. SETTING: Multi-institutional. PATIENTS AND METHODS: Twenty consecutive patients received 100 to 400 mg of fluconazole per day for a median of 30 weeks. All had either failed to respond to treatment with more than 2 g of amphotericin B or had serious amphotericin B-related toxicities. RESULTS: Fourteen of 16 evaluable patients (88%) responded. Responses were observed in seven of nine patients in whom adequate doses of amphotericin B had failed and in all seven patients who had amphotericin B-related toxicities. In 12 patients, cytotoxic chemotherapy was continued without flare of the infection. Fluconazole was well tolerated with rare side effects. Aspergillus superinfection developed in three patients and contributed to the death of two of them. CONCLUSION: Fluconazole is a safe and effective agent with significant activity against chronic disseminated candidiasis.
Respiratory muscle deoxygenation during exercise in patients with heart failure demonstrated with near-infrared spectroscopy. Exertional dyspnea in patients with heart failure may be due, in part, to respiratory muscle underperfusion. Near-infrared spectroscopy is a new technique that permits noninvasive assessment of skeletal muscle oxygenation by monitoring changes in near-infrared light absorption. With use of near-infrared spectroscopy, serratus anterior muscle oxygenation during maximal bicycle exercise was compared in 10 patients with heart failure (ejection fraction 16 +/- 5%) and 7 age-matched normal subjects. Oxygen consumption (VO2), minute ventilation (VE) and arterial saturation were also measured. Changes in difference in absorption between 760 and 800 nm, expressed in arbitrary units, were used to detect muscle deoxygenation. Minimal change in this difference in absorption occurred in normal subjects during exercise, whereas patients with heart failure exhibited progressive changes throughout exercise consistent with respiratory muscle deoxygenation (peak exercise: normal 3 +/- 6, heart failure 12 +/- 4 near-infrared arbitrary units, p less than 0.001). At comparable work loads patients with heart failure had significantly greater minute ventilation and respiratory rate but similar tidal volume when contrasted with normal subjects. However, at peak exercise normal subjects achieved significantly greater minute ventilation and tidal volume with a comparable respiratory rate. No significant arterial desaturation occurred during exercise in either group. These findings indicate that respiratory muscle deoxygenation occurs in patients with heart failure during exercise. This deoxygenation may contribute to the exertional dyspnea experienced by such patients.
The role of second-look surgery in the management of advanced germ cell malignancies. The need for second-look surgery after chemotherapy in children with advanced germ cell tumors is controversial, particularly when levels of the tumor markers alpha-fetoprotein (AFP) or beta-human chorionic gonadotropin (beta HCG) are elevated at diagnosis. The authors evaluated the outcome of second-look surgery in relationship to tumor marker status in 27 patients with Stage III to IV disease who had completed four courses of chemotherapy. Markers were elevated at diagnosis in 19 patients. After chemotherapy, markers normalized in 12 of these patients. Second-look surgery confirmed complete response (CR) in these 12 patients, two of whom had residual masses on computed tomography (CT) scan (mature teratoma and necrotic tumor). The AFP decreased but did not normalize in seven patients; five had residual disease at second look and the other two later developed measurable disease. Of the eight patients with normal AFP at diagnosis, second look confirmed clinical CR in four. The other four patients had CT evidence of residual masses: surgery showed necrotic tissue in two cases, mature glial elements in one, and mature teratoma with glial elements in one. Thus second-look surgery added no information for treatment planning in children with elevated tumor markers at diagnosis and might best be reserved for patients without tumor markers at diagnosis and residual masses on CT scan, and those with persistent elevation of tumor markers and potentially resectable residual disease. Because of the possibility of small amount of residual tumor, second-look surgery may also be useful in patients whose markers normalize but who have residual masses on CT scans.
The skier's nose: a model of cold-induced rhinorrhea. Cold-induced rhinorrhea (CIR) is a commonly experienced discomfort not previously addressed in the medical literature. In a 2-part study, we assessed the prevalence and described the characteristics of CIR and evaluated the efficacy of an anticholinergic nasal spray in its treatment. In Part 1, 90 general medical patients at a ski resort clinic were asked to describe their symptoms associated with cold exposure. Ninety-six percent reported some degree of CIR; 48% reported moderate to severe CIR. Fifty percent had some degree of nasal congestion and 33% reported sneezing. Allergic and nonallergic patients described similar degrees of rhinorrhea. In Part 2, 14 ski patrollers were given atropine sulfate in saline (AS/S) nasal spray before cold exposure in double-blinded placebo (P) controlled crossover fashion. Ninety-two percent noted improvement of CIR with AS/S and 8% experienced no change. None of the subjects noted worsening of symptoms, however, one subject reported excessive dryness at the AS/S concentration used. All 14 subjects receiving P experienced no change in CIR. We conclude that CIR is a distinct clinical syndrome frequently seen with cold temperature exposure, presenting primarily as rhinorrhea and sometimes involving nasal congestion and sneezing. Pretreatment with a 0.005% solution AS/S can effectively block CIR with only minimal short-term side effects.
Inhibitors of hepatic DNA synthesis in fulminant hepatic failure. In certain etiological groups of patients with fulminant hepatic failure, poor survival may be due to lack of liver regeneration. In vitro experiments have shown that fulminant hepatic failure serum is cytotoxic to rabbit hepatocytes and inhibits DNA synthesis on short-term incubation with isolated regenerating rat hepatocytes. When fulminant hepatic failure serum is injected into partially hepatectomized rats at the time of maximal DNA synthesis, [3H]thymidine incorporation into hepatic DNA is reduced significantly. The effect is greater with sera obtained from patients with fulminant hepatic failure due to non-A, non-B hepatitis or an adverse drug reaction and is associated with a less than 10,000-dalton fraction. No stimulation of DNA synthesis is observed with injection of the greater than 10,000-dalton serum fraction into normal rats. In preliminary experiments, no increase in epidermal growth factor production has been found in liver failure. Overall, the substances present in fulminant hepatic failure serum appear to be inhibitory rather than stimulatory for liver cell regeneration.
The motor control assessment: an instrument to measure motor control in physically disabled children. The Motor Control Assessment has been developed as a research tool for the assessment of motor skills in physically disabled children. In tests of concurrent validity it was found to be highly correlated with the results of the Physical Abilities Chart (Pearson coefficient = .96), and satisfactorily correlated with ranking of motor ability assigned using the clinical judgment of physiotherapists (Spearman rank coefficients = .63 to .97 in diagnostic subgroups). Estimates of both interrater and intrarater reliability were also high, with intraclass coefficients above .95.
Diurnal fluctuations of arterial ketone body ratio in normal subjects and patients with liver dysfunction. To explore the metabolic aspects of chronic liver disease, diurnal changes of arterial ketone body ratio (acetoacetate/3-hydroxybutyrate), reflecting hepatic mitochondrial redox potential, were investigated in normal subjects, patients with chronic liver disease (Child's class A or B), and patients with hepatic failure (Child's class C). Ketone body ratio in normal subjects increased after breakfast from 0.96 to 2.00, after lunch from 2.17 to 2.38, and after dinner from 1.23 to 2.55 with blood glucose level ranging from 103 to 141 mg/dL (5.7 to 7.8 mmol/L). By contrast, the ketone body ratio in the Child A or B group changed little and remained within a range of 0.70-1.35 despite a large change in blood glucose level from 102 to 176 mg/dL (5.7 to 9.8 mmol/L). Ketone body ratio in Child's class C remained near or below 0.4 with no response to glucose administration, despite a marked elevation in blood glucose level. These results indicate that hepatic mitochondrial redox potential undergoes diurnal changes in sharp response to meals in normal liver function but that these fluctuations are absent in patients with liver damage (Child's class A, B, and C). Furthermore, it remains at low levels in severe liver failure (Child's class C). It is also suggested that hepatic mitochondrial redox potential plays an important role in the regulation of blood glucose levels.
Prospective evaluation of epidural and intravenous administration of fentanyl for pain control and restoration of ventilatory function following multiple rib fractures. To evaluate the efficacy of opiate administration regimens, 32 patients with multiple rib fractures were prospectively randomized to receive either continuous epidural (ED) or continuous intravenous (IV) infusions of fentanyl. Dosage was titrated to individual subjective pain relief. Ventilatory function tests (VFTs), arterial blood gases (ABGs), and visual analog scores were obtained before and after the institution of analgesia. Post-analgesia values were compared with pre-analgesia values using a two-tailed paired t-test looking for significant changes produced by the analgesic method. Both methods significantly improved analog pain scores. The ED method produced improvement in both maximum inspiratory pressure (MIP) and vital capacity (VC), whereas IV analgesia only produced improvement in VC. Intravenous fentanyl produced increases in PaCO2 and decreases in PaO2, whereas no significant changes in ABGs were observed with ED fentanyl administration. Side effects were similar between the groups, with pruritus being more pronounced with ED fentanyl administration. The data demonstrate that the continuous ED fentanyl method offers excellent relief of pain and improvement in ventilatory function and has distinct advantages over IV fentanyl administration with respect to changes in ABGs and MIP. The continuous infusion of epidural opiates should be the preferred analgesic method for patients at high risk of developing pulmonary complications following multiple rib fractures.
The value of immunological approaches to the diagnosis of schistosomal myelopathy. Myelopathy due to schistosome infection is a rare, yet probably frequently unrecognized, form of schistosomiasis. This condition is clinically difficult to diagnose, and without specific biopsy evidence final confirmation relies largely on circumstantial evidence. We describe here immunological attempts to diagnose schistosomal myelopathy. ELISA performed on the cerebrospinal fluid (CSF) was the most successful, detecting 12/12 cases tested prior to or within one month of treatment. This is based on a "normal" value established on neurological patients without myelopathy. Only 13/149 non-schistosomal myelopathy patients from an endemic area gave positive results in this test. Oligoclonal bands were detected in the CSF of 5/9 schistosomal myelopathy patients and 11/18 cases of myelopathy of other known causes, but in 0/7 cases of myelopathy where the cause was not established. Western blotting was unable to distinguish between myelopathy due to schistosomiasis and other causes. It is recommended that the ELISA be performed on CSF and the results be compared with a "normal" level for neurological patients. In our laboratory this system gives a high sensitivity and a negative result can be confidently used to exclude schistosomal myelopathy.
Topical tretinoin for treatment of photodamaged skin. A multicenter study. The clinical and histologic effects of a new emollient cream formulation of topical tretinoin at concentrations of 0.05% and 0.01% were examined in 251 subjects with mild to moderate photodamaged facial skin in a randomized, double-blind, vehicle-controlled, multicenter study. Seventy-nine percent of the subjects who received 0.05% tretinoin for 24 weeks showed overall improvement in photodamaged skin compared with improvement in 48% of the vehicle-treated control subjects. Significant reductions were found in fine wrinkling, mottled hyperpigmentation, roughness, and laxity after 0.05% tretinoin therapy when compared with controls. In addition, histologic changes of increased epidermal thickness, decreased melanin content, and stratum corneum compaction provide independent evidence supporting clinical improvement. Side effects of erythema, peeling, and stinging were usually mild and well tolerated.
Prognostic value of VEPs in young children with acute onset of cortical blindness. Visual evoked potentials (VEPs) were recorded in 32 children (ages 4 months to 5 years) who were clinically diagnosed as being cortically blind. None of the children had visual or neurologic abnormalities prior to the precipitating insult which included surgery (N = 15), trauma (N = 3), infectious disease (N = 5), hypoxia (N = 3), and other causes (N = 6). VEPs were recorded during the acute stage of cortical blindness in all children and were repeated in 24 of them. Either flash or pattern stimulation was used, depending upon the age and visual status of the child. All but one of the children who had normal flash VEPs while cortically blind, recovered normal visual function. All patients with abnormal VEPs had permanent visual impairment or blindness and all but one of those with absent VEPs remained blind. The recovery period was highly variable, ranging from 5 days to 3 years. Thus, flash VEPs recorded during the period of blindness were useful in predicting visual outcome, regardless of etiology. Repeat studies using pattern VEPs were valuable in monitoring recovery in many of these patients.