shukoor65/lab-rag-model huggingface dataset:
EEG and topographic frequency analysis in common and classic migraine. Electroencephalographic (EEG) changes occurring in patients with migraine have received much attention. However, almost equal number of reports indicate the predominance of normal and abnormal findings. We studied the EEG in symptom-free, otherwise healthy, unmedicated 18-28 year-old patients: 22 with common migraine, 20 with classic migraine, and 20 age-matched controls. The routine EEG findings in the three groups revealed mild non-specific slowing in 2 (9%), 3 (15%) and 2 (10%), respectively. Simultaneously, topographic EEG mapping and frequency analysis were performed in 13 consecutive patients with common migraine, 10 patients with classic migraine and 11 age-matched controls. EEG mapping showed minimal regional differences with lower power in the alpha range in patients with eyes closed. The peak alpha power, as well as its reactivity, were lower among patients than controls. This difference reached statistical significance only for patients with classic migraine versus controls in the left occipital region. Patients also had slightly faster peak alpha frequency. No frank right-left asymmetry was observed in the peak alpha power, neither among the controls, nor the patients. All the findings were rather minor. They may suggest some difference in the posterior background activity in the EEG in migraine patients as compared to the controls, but are not useful in differentiating migraine from non-migraine patients.
Severe limb abnormalities after chorion villus sampling at 56-66 days' gestation Among 289 pregnancies in which chorion villus sampling (CVS) was carried out at 56-66 days' gestation, 5 babies with severe limb abnormalities were subsequently identified. 4 had oromandibular-limb hypogenesis syndromes, and the other had a terminal transverse limb reduction defect. This high incidence raises the possibility that CVS was an aetiological factor for these developmental anomalies.
Gold-associated lymphadenopathy in a patient with rheumatoid arthritis. Histologic and scanning electron microscopic features. The histologic features of adenopathy associated with intramuscular injections of gold sodium thiomalate in a woman with rheumatoid arthritis are presented. We believe that the light microscopic features of the above process are sufficiently distinctive that a diagnosis of gold-associated lymphadenopathy could be rendered. A review of the literature revealed no descriptions of the light microscopic appearance of gold in lymph nodes. In this case, the diagnosis of gold-associated lymphadenopathy was confirmed by scanning electron microscopic studies.
Factors influencing admission blood pressure levels in patients with acute stroke. In clinical practice, patients with acute stroke often have high blood pressure. The aim of this study was to investigate factors correlated with blood pressure elevation in 843 consecutive stroke patients on hospital admission to a nonintensive stroke unit. Using a multivariate analysis model, we analyzed the influence on admission blood pressure of sex, age, previous hypertension, cardiac failure, diabetes, type of stroke, impaired consciousness, and latency between onset of symptoms and admission. Previous hypertension was the strongest predictor (p less than 0.001) of elevated blood pressure on admission, followed by the presence of intracerebral hemorrhage (p less than 0.001). The latency between onset of symptoms and admission showed no correlation with blood pressure levels at hospitalization. Previously, high blood pressure levels on hospital admission have been shown to decline within a few days in hospital. We therefore hypothesize that mental stress on hospital admission may be a major factor in the blood pressure elevation seen in acute stroke.
Congestive heart failure secondary to an arteriovenous fistula from cardiac catheterization and angioplasty. Arteriovenous (AV) fistulae are well known to cause high output cardiac failure. AV fistulae from cardiac catheterization are as rare as 0.01% in the transfemoral approach. We describe here what we believe is the first reported case of high output cardiac failure from an AV fistula due to percutaneous transluminal coronary angioplasty (PTCA). The patient had reversal of the congestive heart failure with surgical correction of the fistula.
Reliability of peak physiological responses during wheelchair ergometry in persons with spinal cord injury. This study examined the test-retest reliability of peak physiological responses during wheelchair ergometry (WE) in individuals with spinal cord injury (SCI). Seven wheelchair dependent subjects, two with paraplegia (T10-11 and T11-12 lesions) and five with quadriplegia (all with C6-7 lesions), were given two incremental exercise tests to volitional fatigue on separate occasions within a one-week period. Each subject wheeled his or her personal wheelchair, which was mounted on a set of frictionless rollers with side-mounted flywheels. Metabolic and cardiorespiratory responses were continuously monitored by means of an automated metabolic measurement cart interfaced with an electrocardiograph. Statistical analysis revealed no significant differences (p greater than .05) between the mean values of the two test trials for six peak values. Reliability coefficients (p less than .01) were: oxygen uptake (0.98), heart rate (0.97), ventilation volume (0.96), respiratory exchange ratio (0.91), oxygen pulse (0.96), and ventilatory equivalent for oxygen (0.88). The investigators concluded that these six physiological responses in subjects with SCI undergoing WE are highly reliable, and that these variables can be used in the objective prescription, monitoring, and evaluation of exercise rehabilitation programs for individuals with SCI.
Thrombotic thrombocytopenic purpura treated with plasma exchange or exchange transfusions. Of 40 patients with thrombotic thrombocytopenic purpura, 17 were treated with plasma exchange, 15 with exchange transfusions, and 6 with both types of therapy. One patient died before being treated and another patient was seen but not treated. Plasma exchange was performed daily for a mean of seven exchanges per patient. The replacement fluid during plasma exchange was fresh frozen plasma in all cases. The complete response rates for each type of treatment were as follows: 88% for plasma exchange (15 patients), 47% for exchange transfusions (7 patients), and 67% for exchange transfusions and plasma exchange (4 patients). Clinical and laboratory factors were examined for any statistically significant association with therapy response. Treatment with plasma exchange was statistically the initial factor most strongly associated with prognosis. Paresis, paresthesias, seizures, mental status change, and coma showed no association with response to treatment. Some of the laboratory factors that did not show significant association with treatment response were the initial creatinine, hemoglobin, platelet count, lactate dehydrogenase, and total bilirubin. This study supports the hypothesis that plasma exchange has significantly improved the prognosis of patients with thrombotic thrombocytopenic purpura. These patients should be treated aggressively regardless of the severity of their symptoms.
c-erbB-2 expression in different histological types of invasive breast carcinoma. Sections of 149 breast carcinomas were examined for the over-expression of c-erbB-2 oncoprotein using the avidin-biotin immunoperoxidase technique and two different specific antibodies. These included the polyclonal antibody 21N and the monoclonal antibody 4D5. The tumours were divided into two main groups. The first included 75 cases of invasive ductal and classic invasive lobular carcinomas. The second group consisted of 74 cases with histological types known to have a good prognosis, including mucinous, alveolar variant of invasive lobular, medullary, tubular, cribriform and papillary carcinomas. Fifteen (20%) tumours of the first group were positive with the two antibodies. Fourteen of these were of the ductal type and one was a mixed invasive ductal and lobular carcinoma. Ten of the pure ductal cases had areas of comedo carcinoma. The intraductal elements in a further tumour were positively stained with 21N antibody only. None of the second group of tumours, which included histological types known to have good prognosis, stained with 4D5, although one mucinous carcinoma was positively stained with 21N. These findings suggest that in invasive breast carcinoma immunostaining for c-erbB-2 is mainly seen in a subgroup of ductal tumours, and that almost all other histological types, especially those associated with good prognosis, lack this expression.
Risk stratification after myocardial infarction with exercise and Doppler echocardiography. Exercise testing early after myocardial infarction has been shown to be of further risk stratification value among otherwise low-risk patients on the basis of an uncomplicated clinical course. The addition of cardiac imaging modalities to exercise testing has augmented this capacity. Exercise echocardiographic imaging before and immediately after treadmill exercise can be accomplished in 85-95% of patients. New or worsening wall motion abnormalities identify 63-80% of patients who will suffer cardiac events and correctly predict 78-95% of those who will not. In addition, exercise echocardiography can detect multivessel coronary artery disease with a sensitivity of 80% and a specificity of 90%. These results are superior to those obtained by analyzing global left ventricular function during exercise, exercise aortic Doppler velocity profiles, or exercise electrocardiography. How exercise echocardiography compares with 201Tl perfusion imaging after myocardial infarction awaits a systematic study. Therefore, the choice between exercise echocardiography and perfusion imaging depends on physician preference, availability, cost, and service.
Cocaine, fetal loss, and the role of the forensic pathologist. Adverse obstetrical outcomes are often associated with maternal cocaine use. These have included intrauterine growth retardation, abruptio placentae, and an increased incidence of spontaneous abortion and pre-term labor. This report details the case of an 18-week-gestation fetus recovered from a sewage treatment plant. A brain specimen was positive for cocaine. With the present epidemic of cocaine abuse, it is important for the forensic pathologist to seek toxicologic evidence of cocaine in all suspicious fetal and neonatal deaths.
Crackles in interstitial lung disease. Comparison of sarcoidosis and fibrosing alveolitis. STUDY OBJECTIVE: Determine why crackles on chest auscultation are characteristic of most interstitial lung diseases, but may not be heard in sarcoidosis. DESIGN: All patients with sarcoidosis or cryptogenic fibrosing alveolitis seen during a four-week period were studied. In a second study to relate ausculatory findings to anatomy, patients with fibrotic changes on their chest roentgenogram were studied. SETTING: Patients were recruited from outpatient clinics. PATIENTS: In the first part, all patients seen over the course of one month were studied. In the second study, patients with pulmonary fibrosis seen on chest roentgenograms were studied. INTERVENTIONS: For the first study, two independent observers performed auscultation on five sites for crackles and reviewed four roentgenogram quadrants for changes. For the second study, patients underwent VC measurements, auscultation, and high resolution computer tomography scans. MEASUREMENTS AND RESULTS: For the first study, crackles were noted at greater than 2 sites in all 11 CFA patients, but only one of 17 SARC patients (p less than 0.001). Roentgenogram changes were seen in greater than 2 quadrants in nine of 11 CFA patients and eight of 17 SARC patients (p = ns). In the second study, the VC was similar in the two groups: SARC: 1.96 +/- .90 L (means +/- SD), 58 +/- 20.4 percent predicted; CFA: 1.81 +/- .33 L, 59 +/- 9.2 percent predicted). Only two of 14 SARC patients had crackles in greater than 1 area, while all 14 CFA patients had crackles at greater than 2 sites. The HRCT studies were read by a radiologist unaware of the diagnosis. The presence and degree (0 to 3 scale) of subpleural and peribronchial fibrosis were scored. Twelve SARC patients had peribronchial changes (mean score 1.9 +/- 1.08), while only eight had subpleural fibrosis (mean score .6 +/- .52). There was a significantly different pattern in the CFA patients, where eight had peribronchial fibrosis (mean score = .9 +/- .78, p less than 0.05) and all 14 had subpleural fibrosis (mean score = 1.6 +/- .73, p less than 0.01). CONCLUSIONS: We conclude that crackles are more frequent in fibrosing alveolitis than in sarcoidosis; this difference may be due to the distribution of parenchymal fibrosis.
The novel competitive N-methyl-D-aspartate (NMDA) antagonist CGP 37849 preferentially induces phencyclidine-like behavioral effects in kindled rats: attenuation by manipulation of dopamine, alpha-1 and serotonin1A receptors. The novel competitive N-methyl-D-aspartate (NMDA) receptor antagonist DL-(E)-2-amino-4-methyl-5-phosphono-3-pentenoic acid (CGP 37849) was found to produce a phencyclidine (PCP)-like behavioral syndrome (ataxia, locomotion, stereotypies) in amygdala-kindled rats, whereas the amphetamine-like behavioral alterations of the syndrome (locomotion, stereotypies) were only infrequently seen in nonkindled rats. In dose-response experiments in kindled and nonkindled rats, behavioral effects were scored using a ranked intensity scale, and the behaviors and behavioural scores determined after CGP 37849 were compared with those determined after i.p. administration of the noncompetitive NMDA receptor antagonist dizocilpine maleate (MK-801). In kindled rats, 20 mg/kg of CGP 37849 produced about the same scores for hyperlocomotion and head weaving as 0.1 mg/kg of MK-801. Kindled rats exhibited higher behavioral scores than nonkindled rats, especially in the case of CGP 37849. The behavioral effects produced by CGP 37849 in kindled rats were almost indistinguishable from the PCP-like behavioral effects induced by MK-801, indicating that CGP 37849 indeed produces a PCP-like pattern of behavior in kindled rats. Hyperlocomotion and head weaving induced by CGP 37849 in kindled rats could be attenuated or totally prevented by pretreatment with ipsapirone, a partial agonist/antagonist at postsynaptic 5-hydroxytryptamine (5-HT) receptors of the 5-HT1A subtype. Furthermore, these behavioural effects were attenuated or blocked by the dopamine antagonist haloperidol and the alpha-1 adrenoceptor antagonist, prazosin. The data demonstrate that kindling induces a hypersensitivity to PCP-like behavioral effects of competitive and noncompetitive NMDA receptor antagonists, which could relate to the recent finding of increased function of NMDA receptors following kindling.
Electrocardiographic diagnosis of left ventricular hypertrophy in the presence of bundle branch block. Autopsy and echocardiographic studies indicate that ECG criteria for LVH tend to maintain their sensitivity in the presence of LBBB, with the exception of left precordial lead criteria alone. With RBBB, ECG criteria for LVH using right precordial S waves and combination criteria of right precordial S waves and left precordial R waves have a marked reduction in sensitivity, whereas left precordial R wave criteria have modestly reduced sensitivity. Limb lead criteria for LVH have increased sensitivity in the presence of RBBB and, to a lesser extent, in the presence of LBBB. Acceptable sensitivity for the diagnosis of LVH in patients with bundle branch block requires a combination of limb and precordial lead voltage criteria and/or other nonvoltage ECG criteria, since the prevalence of LVH in the presence of RBBB or LBBB appears higher than the sensitivity of individual criteria.
Peritoneal leukocyte response following placement of polyglycolic acid intestinal sling in patients with rectal carcinoma. The intestinal sling procedure has been used successfully without the observance of pelvic infections. This procedure involves the implantation of polyglycolic acid (PGA) mesh to hold the bowel out of the pelvis to prevent radiation enteritis. We previously showed that PGA mesh has no intrinsic bactericidal activity. Since phagocytic leukocytes produce reactive oxygen intermediates during respiratory burst that are associated with oxygen-dependent bactericidal activity, we examined peritoneal cell types and their respiratory burst activity isolated from patients with biopsy-confirmed rectal carcinoma who underwent the intestinal sling procedure (N = 12) compared with patients who did not (N = 13). There was no significant difference in the cell types within the peritoneal cavity over the 7-day postoperative period examined. However, there was a significant increase in the ability of leukocytes isolated from mesh patients to produce hydrogen peroxide in the absence of an exogenous stimulus (P less than 0.05), as measured by flow cytometric quantitation of oxidation of the hydroperoxide-sensitive dye, 2',7'-dichlorofluorescin diacetate (DCFH-DA). Despite the higher endogenous DCFH oxidation by leukocytes from mesh patients, the cells retained the ability to oxidize DCFH following treatment with a membrane-active stimulant for respiratory burst activity, 12-O-tetradecanoyl-phorbol-13-acetate. These observations suggest that PGA mesh used for the intestinal sling procedure stimulates the respiratory burst activity of peritoneal leukocytes during the postoperative period in which bacterial proliferation and colonization occur. The stimulation of reactive oxygen intermediates involved in oxygen-dependent bactericidal activity by PGA mesh may be one of the mechanisms underlying the lack of infections observed with the use of PGA mesh in contaminated settings.
Topographic variations in the peripheral course of the greater occipital nerve. Autopsy study with clinical correlations. The description of the peripheral course of the greater occipital nerve (GON) varies in the literature. An autopsy study was done on 20 cases without known headache problems. These findings showed a marked variation in the relation between the GON and nuchal muscles. The trapezius muscle was penetrated by the GON in 45% of cases, the semispinal muscle of the head was penetrated in 90% of cases, and the inferior oblique muscle of head was penetrated in 7.5% of cases. Macroscopic findings of possible compression were made in 11 cases (27.5%), indicating that nerve compression per se may be of minor importance since it seems to exist in the absence of headache.
MRI reveals multiple reversible cerebral lesions in an attack of acute intermittent porphyria. A 20-year-old woman had an attack of acute intermittent porphyria (AIP) with seizures and hallucinations. MRI revealed multiple lesions in both hemispheres. Both the cerebral clinical abnormalities and the MRI lesions resolved following treatment. These findings suggest that a vascular mechanism may underlie the pathogenesis of cerebral dysfunction in AIP.
Acute effects of alpha- and beta-adrenoceptor blockade on plasma atrial natriuretic peptides during exercise in elderly patients with mild hypertension. In a randomized study in 26 elderly patients with mild essential hypertension, acute effects of alpha- and beta-adrenoceptor blockade on plasma ANP levels were examined at rest and during ergometric exercise. Plasma ANP level and LVEF were measured before and after administration of prazosin (an alpha 1-adrenergic blocker), atenolol (a cardioselective beta-adrenergic blocker), or carteolol (a nonselective beta-adrenergic blocker). Plasma ANP level was increased by exercise. Carteolol and atenolol increased plasma ANP levels at rest and during exercise, but the effect of atenolol was not statistically significant. Prazosin significantly suppressed the ANP values at rest and during exercise. The LVEF was increased by prazosin and decreased by beta-blockers, especially by carteolol. Multivariate regression analysis showed that LVEF was the most significant predictor of the plasma ANP level at maximal exercise; the resting blood pressure and heart rate were not predictors of this value. The results showed that single administrations of an alpha-blocker and a nonselective beta-blocker had opposite effects on the plasma ANP level both at rest and during exercise in elderly patients with mild essential hypertension. The observed difference in the ANP response seems to be related to changes in left ventricular function rather than changes in blood pressure or heart rate.
Carrying as colic "therapy": a randomized controlled trial. In healthy infants, crying behavior is reduced significantly by "supplemental" carrying; that is, increased carrying throughout the day in addition to that which occurs during feeding and in response to crying. To determine whether the recommendation to increase carrying would be effective as a therapy for colic, 66 mothers of infants 4 weeks of age or less who came to their pediatricians with complaints of crying problems ("colic") were randomized to receive standard pediatric advice (standard group) or standard advice plus the recommendation to increase supplemental carrying by 50% (supplemental group). Overall, the supplemental group carried their infants 6.1 hours/d throughout the intervention period, an increase of 2.2 hours/d (56%) more than that provided by the standard group. Despite this significant increase in carrying, there was no difference between groups in the duration or frequency of crying, fussing, or cry/fuss at any time throughout the intervention period. When the greatest treatment effect was expected at 6 weeks, the supplemental group infants cried only 3 minutes less per day (95% confidence interval: 37 minutes less to 32 minutes more per day). We conclude that, compared with standard pediatric advice to be "responsive," supplemental carrying does not reduce crying and fussing behavior further in infants who have colic. In marked contrast to healthy infants, this apparent resistance to increased carrying may indicate an important difference in state regulation and control in infants with colic.
Angiotensin-induced growth related metabolism is activated in cultured smooth muscle cells from spontaneously hypertensive rats and Wistar-Kyoto rats. Smooth muscle cells from spontaneously hypertensive rats (SHR) proliferate in culture faster than those isolated from sex- and age-matched Wistar-Kyoto (WKY) animals. There was no difference in the kinetics of S6 kinase activation in the two cultures, but later metabolic events associated with proliferation were stimulated earlier in SHR cells than in WKY, eg, activation of ornithine decarboxylase. Both cell types elaborated an extensive extra-cellular matrix in culture composed of a different blend of connective tissue macromolecules. Matrix material from SHR cells was more stimulatory to growth of WKY cultures than their own matrices. Angiotensin stimulated the growth and synthesis of extra-cellular matrix material in SHR more than in WKY derived vascular smooth muscle cell cultures.
Relationship between coronary blood flow and perfusion pressure during reactive hyperemia: a case report in an awake unanesthetized woman with normal coronary arteries. The linear relationship between coronary blood flow and mean arterial pressure during reactive hyperemia is presented for the first time in an awake unanesthetized woman with normal coronary arteries during systemic hypotension induced by pharmacologic vasodilation. This case demonstrates the critical dependence of coronary flow reserve on simultaneous perfusion pressure.