shukoor65/lab-rag-model huggingface dataset:
Children with pervasive refusal. Four children are described with a potentially life threatening condition manifested by profound and pervasive refusal to eat, drink, walk, talk, or care for themselves in any way over a period of several months. The multiplicity and severity of the symptoms in these children do not fit comfortably into any existing diagnostic category. Long term and highly skilled nursing and psychiatric care is required to help these children to recover. The possible causes of this syndrome are discussed.
Optimal right ventricular filling pressures and the role of pericardial constraint in right ventricular infarction in dogs. BACKGROUND. Previous studies have reported an important role for right ventricular function in the pathophysiology of the low cardiac output state that can accompany right ventricular infarction. Some studies have suggested that right ventricular distensibility impairs right ventricular filling and stroke output; others have demonstrated that the pericardium can mediate depressed left ventricular filling and stroke output. METHODS AND RESULTS. To determine the role of pericardial constraint and optimal volume loading in an experimental model of right ventricular wall infarction, six mongrel dogs were studied before and after right ventricular wall infarction and after volume loading. The pericardium was then opened in two phases. In the first phase, the pericardium was opened partially to allow the atria to distend freely, and in the second phase, the pericardium was opened completely. The animals were preinstrumented with two sets of piezoelectric crystals attached to the right ventricular free wall, one in the infarct and the other in the noninfarct territory. Left ventricular size was estimated by left ventricular crystals on the anterior wall of the left ventricle. Right ventricular and left ventricular Millar catheters were used to assess intracavitary pressure, and a flat balloon was used to assess intrapericardial pressure. Right ventricular infarction reduced cardiac output by 23% and stroke volume by 30%. End-diastolic segment length and transmural pressure of the left ventricle decreased. Volume loading restored cardiac output to baseline values and was mediated by a significant increase in end-diastolic length in the noninfarct territory. This was achieved by increasing right ventricular end-diastolic pressure from 9 +/- 2 to 16 +/- 3 mm Hg (p less than 0.01). Partial opening of the pericardium mediated significant increases in both end-diastolic segment lengths of the left ventricle and the noninfarct territory. Left ventricular end-diastolic pressure decreased slightly by 3 mm Hg (p = NS). Complete opening of the pericardium increased cardiac output and stroke volume and mediated a significant decrease in right and left ventricular end-diastolic pressures. Left ventricular transmural pressure and end-diastolic segment lengths of the left ventricle and the noninfarct territory increased. Left ventricular diastolic pressure-segment length relations were shifted upward by right ventricular infarction. A partial opening of the pericardium shifted this relation downward in all animals, and complete opening of the pericardium shifted the relation rightward and further downward. CONCLUSIONS. Cardiac output is restored to baseline values by volume loading sufficient to increase the right ventricular diastolic pressure to 16 +/- 3 mm Hg. Evidence of pericardial constraint was observed and appears to be mediated by an atrioventricular interaction in addition to the direct ventricular interaction.
Peripheral arterial occlusion in infants--a report of two cases treated conservatively. The occlusion of major arteries in newborns is usually associated with catheterization of the umbilical vessels. It occurs very rarely instead as a primary disorder, and the cause is still unclear. We present two new cases of newborns with this type of disease, which were resolved with the only medical treatment. The literature is reviewed, and the usefulness of the different diagnostic procedures is discussed.
Calcium channel autoantibodies in the Lambert-Eaton myasthenic syndrome. We have tested 36 patients with the Lambert-Eaton myasthenic syndrome for serum antibodies to voltage-gated calcium channels by using an immunoprecipitation assay with [125I] omega-conotoxin-labeled voltage-gated calcium channels extracted from a human neuroblastoma cell line, SKN-SH. Forty-four percent of these patients had significant levels of antibody (30-1,466 pM) compared with healthy control individuals (less than 15 pM). The incidence of positive sera in patients without associated small cell lung carcinoma (61%) was greater than in those patients with small cell lung carcinoma (28%). Results correlated strongly with results obtained using voltage-gated calcium channels extracted from the small cell lung carcinoma line, MAR5. Anti-voltage-gated calcium channel antibody titers did not correlate with disease severity across individuals, but longitudinal studies in 2 patients receiving immunosuppressive therapy showed a clear inverse relation between antibody titer and an electromyographic index of disease severity. The incidence of positive sera among patients with other neurological disorders was not significant, but 8 of 12 patients with rheumatoid arthritis or systemic lupus erythematosus had raised titers (30-82 pM). We conclude that the antibodies detected in this assay are heterogeneous and that some of them are likely to be implicated in this disorder of neuromuscular transmission. The assay should prove useful as an additional diagnostic aid in patients with Lambert-Eaton myasthenic syndrome.
Noninvasive diagnostic assessment of peripheral vascular disease. Noninvasive techniques have assumed an increasingly important role in the management of patients with vascular disease. Both ultrasonic and plethysmographic instruments allow objective evaluation of vascular disorders by the measurement of segmental limb blood pressures, analysis of blood velocity disturbances, recording of digit or limb pulse waveforms, or imaging of vascular disease, with or without Doppler flow analysis or color-flow mapping. These techniques have been applied for screening asymptomatic individuals, diagnosis of symptomatic patients, monitoring of interventional or surgical procedures, and follow-up of the natural history or the efficacy of medical, interventional, or surgical therapy of vascular disease. This article reviews the clinical application of these modalities to patients with peripheral arterial disease and briefly discusses cost-effectiveness and potential abuses of noninvasive technology.
The role of radiology in evaluation of the failing renal transplantation. Renal allograft transplantation frequently is the optimal treatment for patients in renal failure. This review discusses the current status of renal transplantation, emphasizing the medical and surgical processes that can interfere with normal renal function. Although many insults to the renal allograft are nonspecific, a logical approach to the identification of the decrease in renal function and appropriate treatment can be suggested by some imaging procedures.
Interleukin 6 activity in infants and children with bacterial meningitis. The Collaborative Study on Meningitis. Concentrations of interleukin 6 (IL-6) in cerebrospinal fluid (CSF) and serum of infants and children with bacterial meningitis were determined and correlations were sought with other indices of inflammation and with outcome. Forty-two patients ages 1 month to 15 years (mean, 2.5 years) were studied. IL-6 activity was detectable (greater than 50 units/ml) in 30 of 36 CSF samples collected at admission from patients with meningitis and in 1 of 23 controls with fever and normal CSF findings. Mean values were 36,000 units/ml (range, 151-156,000). IL-6 activity in CSF persisted during the first 5 days of illness. IL-6 concentrations at admission were not associated with clinical findings, CSF leukocyte, protein and glucose concentrations, serum C-reactive protein concentration and neurologic complications or sequelae. IL-6 was also detected in the serum of 3 of 14 patients with meningitis and in 0 of 7 controls with no infectious disease. The presence of IL-6 was not associated with bacteremia or with duration of fever before admission. The presence of IL-6 in the CSF of pediatric patients with bacterial meningitis is in accordance with available data on other cytokines and suggests their role as mediators of meningeal inflammation.
Seasonal variation in growth during growth hormone therapy. Seasonal variation in growth of normal children has been well described, although the mechanism by which it occurs has not been elucidated. The growth of 52 growth hormone-deficient children treated with synthetic human growth hormone was analyzed. A similar seasonal variation was observed, with mean (+/- SEM) peak growth occurring in the summer (8.2 +/- 0.3 cm/y) and winter (7.7 +/- 0.2 cm/y), and trough growth occurring in the autumn (6.9 +/- 0.3 cm/y). Forty-seven percent of subjects grew minimally during the autumn, and only two children showed peak growth in that season. Individual variations between maximal and minimal growth seasons amounted to 3.5 +/- 0.3 cm/y. The seasonal pattern was statistically significant for the group as a whole, for the prepubertal subgroup, and for the boys. The variation persisted when the first year of treatment was excluded to avoid bias of the initial growth spurt. The season of onset of therapy did not affect total growth during the first year. The demonstration of a seasonal pattern in growth of these children suggests that the seasonal variation may be mediated by peripheral rather than central factors. Paired clonidine-provoked growth hormone levels and an integrated concentration of 24-hour growth hormone levels and serum levels of insulinlike growth hormone I measured in a control group of normally growing children were also analyzed and showed no seasonal variation. This further suggests that peripheral rather than central factors are responsible for the seasonal variation in children's growth.
Erythropoietic protoporphyria: unusual skin and neurological problems after liver transplantation. The case of a woman with protoporphyria who developed liver failure and underwent liver transplantation is described. During the pretransplant episode of liver failure she developed quadriparesis that rapidly progressed after transplantation to a severe polyneuropathy. Following transplantation she also developed a second-degree burn of the light-exposed abdominal wall. The neuropathy resembled that observed in other forms of porphyria, and it is proposed that the extreme disturbance of protoporphyrin levels associated with protoporphyrin-induced liver failure caused this neuropathy. Such a neuropathy has not previously been described in protoporphyria. Erythrocyte protoporphyrin levels remain high and fecal levels normal, although results of liver tests are normal. She remains photosensitive, which emphasizes that although liver transplantation may be lifesaving in this disorder, it is not curative, and care must be taken to prevent photosensitive damage to skin and light-exposed internal organs.
Intrascrotal adenomatoid tumors. Adenomatoid tumors are regarded as uncommon neoplasms of the paratesticular tissues, probably of mesothelial origin. The majority of cases reported have involved the epididymis. We report our experience with 8 cases of testicular tumors and 11 of epididymal adenomatoid tumors during a 13-year period, and review the relevant literature. The incidence of adenomatoid tumors relative to all tumors in the testis was 6.9% (8 of 116), exceeding that of Leydig cell tumors, which were previously believed to be the most common benign testicular neoplasms. The adenomatoid tumors included 38% epididymal tumors (11 of 29). The clinical course of the tumors was benign, without recurrences. Local excision is regarded as the treatment of choice for epididymal and testicular adenomatoid tumors.
Contractile properties of lower leg muscles are normal in Parkinson's disease. Contraction parameters (time-to-peak and half relaxation time), responses to short tetani and resistance to stretch were studied in the lower leg muscles of Parkinsonian patients and in age-matched controls. It was possible to distinguish between muscle groups of different fibre type composition in normal subjects on the basis of their contraction and relaxation velocities. These parameters, however, failed to show any abnormalities in the patient group. The only abnormal finding in Parkinsonian subjects was an increased resistance to passive stretch under static conditions, presumably elastic in origin. The results are evidence against a contribution of altered contractile properties to muscular rigidity in Parkinsonism.
Ureteral obstruction after abdominal aortic surgery. Obstructive uropathy following abdominal aortic surgery can no longer be considered a rarity. Early hydronephrosis, developing in the first postoperative year, occurs in 10% to 20% of patients; it usually runs a benign, self-limiting course. The incidence of delayed ureteral obstruction, which develops or persists after the first postoperative year, is unknown because it is asymptomatic in most cases. Although spontaneous resolution is possible, it seems that this late form is more likely to persist. The diagnosis of postoperative hydronephrosis is not an indication for urologic intervention. This should seldom be necessary; it should be reserved only for patients with evidence of worsening obstruction or deteriorating renal function. Early and particularly, delayed hydronephrosis seems to be a marker for present or impending graft complications, such as infection or false aneurysms. A prolonged follow-up is therefore mandatory whenever the diagnosis is established as it may improve long-term survival and limb salvage. The need for routine screening for this condition remains to be established. With the availability of noninvasive methods, such a task could be easily accomplished.
Antimicrobial treatment of acute otitis media. No single antimicrobial drug is best suited for all patients with AOM. Amoxicillin and TMP-SMZ, however, remain first-line drugs in the initial treatment of uncomplicated AOM in the non-neonate. In other situations the drug selected depends on the patient's age, associated illnesses, recent history of otitis media, and drug hypersensitivity. Pharmacokinetic studies of AOM treatment are essential in generating more precise recommendations for antimicrobial drug use.
A phase II study of high-dose continuous infusion interleukin-2 with lymphokine-activated killer cells in patients with metastatic melanoma. Thirty-three patients with metastatic melanoma were treated in a phase II study with an intravenous continuous infusion (IVCI) of interleukin-2 (IL2) given with lymphokine-activated killer (LAK) cells. The dose of IL2 was the optimal priming dose for LAK-cell induction, followed by the maximally tolerated LAK-cell dose that could be given by an IVCI schedule as determined by a previous phase I trial. The CI schedule was chosen for evaluation because of a postulated reduction in toxicity with the possibility of administering a more prolonged IL2 infusion and because greater rebound lymphocytosis and LAK-cell generation had been reported using this dose and schedule. The 33 patients were similar in age, performance status, and sites of disease to those treated in previous IL2 trials. All patients were assessable for response and toxicity. One patient (3%) achieved a partial response of 10 months duration. There were no other clinically significant responses. Significant toxicity included hypotension requiring pressors (45%), dyspnea (36%), renal insufficiency (24%), hepatic dysfunction (66%), and cardiac arrhythmias (18%). These toxicities reversed with cessation of the infusion. There were four deaths during the first 30 days of treatment, three from infection (one related to central line, one related to LAK cells, one related to tumor), and one from tumor-related hemorrhage. Toxicity was unexpectedly high and at least comparable to that seen in previous studies using a high-dose IV bolus schedule of IL2. When comparing the IVCI schedule with high-dose bolus IL2 to LAK cells in nonrandomized but sequential studies in patients with advanced melanoma, it appears that CI IL2 is less efficacious.
Unusual initial calcification of primary and metastatic seminomas. Detection by computed tomography. Rare large ab initio calcifications of a primary mediastinal seminoma in a 16-year-old boy and of para-aortic nodal metastatic ovarian seminoma in a 14-year-old girl are demonstrated with CT but not with conventional radiography. They are most likely dystrophic calcifications because of the absence of other germ cell tumor components and infective granulomatous disease. Routine use of CT might detect more such calcifications in untreated seminoma.
Assessment of factors influencing the outcome of radiotherapy for bladder cancer. The results of treatment of 709 patients with carcinoma of the bladder are reported. Inclusion of the pelvic lymph nodes in the treatment volume failed to lead to any improvement in survival. The factors influencing survival were stage, tumour histology and differentiation. The presence of tumour at follow-up cystoscopy at 3 months was of great prognostic significance.
Urological manifestations of the Melnick-Needles syndrome: a case report and review of the literature. In 1966 Melnick and Needles described a syndrome of multiple skeletal anomalies in a 3-year-old girl. A dilated ureter was noted but not associated with the disorder. Subsequent to this report there have been 8 additional cases published of patients with the Melnick-Needles syndrome in association with a variety of urogenital and abdominal wall abnormalities. A 10-year-old girl with this syndrome and bilateral ureteral ectasia is described and the literature on this association is reviewed.
Poorly differentiated adenocarcinoma with lymphoid stroma (lymphoepithelioma-like carcinomas) of the stomach. Report of three cases with Epstein-Barr virus genome demonstrated by the polymerase chain reaction. Lymphoepithelioma of the nasopharynx is an undifferentiated carcinoma with prominent lymphoid infiltration. Histologically similar tumors have been documented in the skin, lung, thymus, salivary gland, tonsil, and uterine cervix. The authors report three cases of gastric carcinoma that were histologically and immunohistochemically similar to lymphoepithelioma. The patients were elderly white persons (61, 76, and 77 years of age); two of them had previous partial gastric resections for benign ulcer disease. The tumors were located on the lesser gastric curvature (two cases) and at a previous anastomotic site (one case) and measured 3, 4, and 7 cm in largest dimension. Grossly, each neoplasm was a raised plaque-like lesion with a central ulcer. Microscopically, all three tumors were similar, with poorly differentiated polygonal tumor cells scattered throughout a dense lymphocytic background. In a few areas, tumor cells formed ill-defined cords. In two cases, the neoplasms invaded the gastric muscle layer but had a well-delineated (pushing) margin. The tumor cells were immunohistochemically positive for AE3-defined keratin, confirming their epithelial nature. The lymphocytes were a mixture of UCHL-1-positive T cells and L-26-positive B cells. Portions of the Epstein-Barr virus genome were present in all cases, as detected by the polymerase chain reaction. The morphologic features of these cases are similar to those of lymphoepithelioma in other anatomic sites, and these tumors represent a unique subtype of gastric carcinoma.
Practice patterns in the treatment of acutely ill hospitalized asthmatic patients at three teaching hospitals. Variability in resource utilization. STUDY OBJECTIVE: Our objective was to determine the extent to which patterns of diagnostic and therapeutic practice differ among hospitals caring for acutely ill hospitalized asthmatic patients in a single city. DESIGN: Our study comprised a retrospective review of the records of patients admitted to the hospital for the treatment of acute asthma. SETTING: Three large teaching hospitals in Boston were the setting. PATIENTS: One hundred twenty-seven patients between 18 and 50 years of age who were admitted to the medical services specifically for the treatment of asthma were studied. INTERVENTIONS: There were no interventions. MEASUREMENTS AND MAIN RESULTS: For this group of patients with similar histories of asthma, clinical presentation, and severity of asthma, the diagnostic tests used within 12 hours of admission and the frequency and volume of diagnostic laboratory testing throughout the admission differed significantly among the three hospitals. Spirometry, the test bearing most directly on the severity of the asthmatic attack, was not used routinely as a criterion for admission or discharge at any of the hospitals. Other tests of uncertain efficacy, such as chest x-ray films, were used frequently at some of the hospitals. Patients at all three hospitals were treated similarly with intensive combined regimens of methylxanthines, sympathomimetics, and corticosteroids and had similar mean lengths of stay. The use of chest physical therapy, which has not yet been demonstrated to be effective in acute asthma, differed significantly among the three hospitals. CONCLUSIONS: We conclude that considerable variability exists in the diagnostic evaluation of acutely ill hospitalized asthmatic patients in the three hospitals; little variability exists in the pharmacologic treatment of these patients. In the absence of data on outcome regarding functional improvement and reductions in morbidity, we are unable to recommend a preferred pattern of practice from this study.
Correlation of emergency health care use, 911 volume, and jail activity with welfare check distribution. STUDY OBJECTIVES: The purpose of this study was to examine the relationship among emergency health care use, 911 call volume, and jail admissions with the timing of the distribution of General Assistance, Aid to Families With Dependent Children, and Minnesota Supplemental Aid welfare checks. DESIGN: This was a retrospective study analyzing previously collected census and welfare check distribution data. SETTING: The data used in this study were obtained from the Hennepin County Medical Center, the Hennepin County jail and alcoholic receiving center, and Department of Economic Assistance. INTERVENTIONS: The daily census for the years 1986 through 1988 in the Hennepin County Medical Center emergency department, ED resuscitation room, pediatric ED, crisis intervention center, urgent care center, and alcoholic receiving center was obtained. The numbers of daily ambulance runs, nonelective hospital admissions, Hennepin County 911 calls, and Hennepin County jail admissions for the same years also were obtained. Means for each day of the month were computed across the 36 months of observation. These data were correlated with the number of days elapsed since the monthly issuance of the General Assistance, Aid to Families With Dependent Children, and Minnesota Supplemental Aid welfare checks. MEASUREMENTS and MAIN RESULTS: There were significant correlations between the number of days after distribution of the checks and the average values of the census of the alcoholic receiving center (r = -.96, P less than .00001), the ED (r = -.80, P less than .0001), ambulance runs (r = -.68, P less than .0001), 911 calls (r = -.45, P = .01), jail admissions (r = -.45, P = .01), nonelective hospital admissions (r = -.44, P = .01), and the crisis intervention center visits (r = -.39, P = .03). CONCLUSIONS: The findings suggest that scheduling and staffing practices of various emergency service areas in Hennepin County reflect patient load variation associated with time of welfare check distribution. Systematic variation of time or amount of welfare could lead to improved distribution and reduction of emergency services demand.