shukoor65/lab-rag-model huggingface dataset:
Management of patients aged over 60 years with supratentorial glioma: lessons from an audit. This audit of clinical management confirmed the poor prognosis for patients (n = 80) aged over 60 years with a diagnosis of supratentorial glioma. The median survival time after diagnosis was 9 weeks following steroids and 7 weeks after biopsy and steroids. Cytoreductive surgery and radiotherapy improved median survival time by a maximum of 16 weeks, but there was significant morbidity in some patients undergoing craniotomy. Although 92% of the biopsied lesions were either glioblastoma or anaplastic astrocytoma, the median survival of these patients was similar to the 8% of patients confirmed as having intermediate grade astrocytoma. Patients presenting with minimal functional deficit (WHO grade I or II) had longer median survival times than those presenting in poor condition (WHO grade III or IV). In this series there was no relationship between management undertaken and clinical status of the patient. The 9% of the cohort that survived 1 year were treated in a variety of ways. This audit, together with results from other studies, suggests that a prospective clinical trial of different management regimes in elderly patients with supratentorial gliomas is needed. Since median survival time in the most intensively treated patients will be around 6 months, treatment evaluation must consider the quality of life provided.
Helicobacter pylori in children with peptic ulcer and their families. Little is known about the source and spread of Helicobacter pylori, but transmission from infected family contacts has been suggested. We have therefore investigated 15 children with peptic ulcer and their first-degree relatives for H. pylori. Serum anti-H. pylori IgG, pepsinogen I, and gastrin levels were measured. Endoscopy was carried out on the children and relatives, and biopsies were taken from the gastric antrum for histology, microbiology, and urease testing. Six of 11 children with duodenal ulcer (55%) and two of four children with gastric ulcer (50%) were positive for H. pylori. Fourteen of 16 parents (87%) and eight of 13 siblings (61%) of H. pylori-positive children with peptic ulcer were also infected compared with eight of 14 parents (57%) and none of four siblings of H. pylori-negative children with peptic ulcer (P less than 0.10, greater than 0.05, and NS, respectively). The children with H. pylori-negative peptic ulcer and negative siblings combined were younger than positive children with peptic ulcer and positive siblings (P less than 0.001). The reliability of serum anti-H. pylori IgG level as a screening test for infection was confirmed. These findings call into question a pathogenetic role for H. pylori in some childhood peptic ulceration, but do suggest that person-to-person spread of infection occurs.
Noninvasive diagnosis of vascular trauma by duplex ultrasonography. Duplex ultrasonography was used prospectively in the initial evaluation of 198 patients with 319 potential vascular injuries of the neck and extremities. Patients who were unstable or who had obvious arterial trauma were excluded. Injury was caused by gunshot in 104 (53%), blunt trauma in 42 (21%), stab wound in 34 (17%), and shotgun in 18 (9%). Duplex ultrasonography correctly characterized and localized vascular injuries in 23 patients: arterial disruptions (13), intimal flaps (4), acute pseudoaneurysms (3), arteriovenous fistulas (2), and shotgun pellet arteriopuncture (1). Nineteen other patients had vasospasm (13) or external compression (6) without evidence of intrinsic vessel injury, these 42 studies had true-positive results. Twenty patients underwent arterial repair (13 on the basis of duplex ultrasonography alone), one had primary amputation, three required fasciotomy, and 18 were observed. Two patients with false-negative results had minor shotgun pellet arteriopunctures that were missed by duplex ultrasonography, but neither needed repair. One hundred fifty-three patients had true-negative results on duplex ultrasonography: all clinically had only proximity injuries and easily palpable distal pulses. The result of one duplex ultrasonography study was found to be false-positive on arteriography. The sensitivity of duplex ultrasonography was 95%, the specificity was 99%, and the overall accuracy was 98%. These results closely approximate those reported with the use of exclusion arteriography in the evaluation of similar vascular trauma patients. Furthermore, duplex ultrasonography has no interventional risks and is more cost-effective for screening such injuries than arteriography or exploration. Duplex ultrasonography is a reliable method of diagnosis in patients with potential peripheral vascular injuries.
Positron emission tomography demonstrates that coronary sinus retroperfusion can restore regional myocardial perfusion and preserve metabolism. Positron emission tomography was used to image blood flow and metabolic tracers in risk zone myocardium after left anterior descending coronary artery occlusion during synchronized coronary venous retroperfusion. Six control and seven intervention open chest dogs had occlusion of the mid left anterior descending coronary artery. Synchronized retroperfusion commenced 25 min later. Flow tracers (rubidium-82 and nitrogen-13 ammonia) were injected retrogradely. Three hours after coronary occlusion, fluorine-18 (F-18) deoxyglucose uptake in the control and treatment groups was compared. At 200 min of occlusion, infarct size was assessed. Retrograde flow tracer uptake was observed in the risk zone in the seven intervention dogs. Fluorine-18 deoxyglucose uptake in the risk zone was increased in five of the six intervention dogs but was reduced in five of the six control dogs. The risk zone to normal zone F-18 deoxyglucose count ratio was higher in the intervention than the control group (1.13 +/- 0.39 vs. 0.59 +/- 0.51; p less than 0.05). The endocardial subsegment risk zone to normal zone F-18 deoxyglucose count ratio was also significantly higher in the intervention group. Percent infarction in the risk zone was 70% lower in the group treated with synchronized retroperfusion than in the control group (18.4 +/- 22.6% vs. 61.2 +/- 25.4%; p less than 0.02). Thus, positron emission tomography revealed that retroperfusion could deliver oxygenated blood and maintain metabolism in risk zone myocardium. Infarct size was limited to 30% of that of control. In acute closure of the left anterior descending coronary artery, synchronized retroperfusion might be considered for maintaining viability of the jeopardized myocardium if the artery cannot be reopened rapidly.
Lamina repair and replacement to control laminectomy membrane formation in dogs. This study examined the efficacy of lamina repair by the use of various techniques to prevent postlaminectomy scar formation in a canine system. Five-level noncontiguous laminectomies were performed on six adult canines. The most caudal (Site 1) was left uncovered and served as the control. Exposed dura at each of the remaining four levels was covered with one of the following: Site 2, free autogenous laminar bone graft; Site 3, polymethylmethacrylate; Site 4, Teflon-Proplast composite; Site 5, collagen gel. The dogs used in the study were killed 16 weeks after surgery. Three specimens were examined by plain roentgenography and computerized tomography, two specimens were examined histologically, and the remaining four specimens were graded according to scar volume and scar adherence, as detected during gross dissection of the postlaminectomy scar. No repair technique interfered with roentgenography evaluation. The least scar and fewest adhesions were present under the free bone graft repair site. The Teflon-Proplast composite and polymethylmethacrylate both limited the amount and adherence of scar. Collagen gel and control sites were indistinguishable in this study. It is concluded that lamina repair with a solid material covering exposed dura significantly reduces the formation of postlaminectomy membrane and scar.
2-D echocardiography: emergent use in the evaluation of penetrating precordial trauma. Diagnosis of cardiac injury in stable patients suffering penetrating precordial trauma has relied on observation, subxiphoid window, or exploratory thoracotomy. Previous reports have stressed the need for an alternative noninvasive diagnostic test. Although the use of echocardiography (ECHO) in this patient population has been suggested, to our knowledge no report thus far has presented extensive experience with this technique. We present our experience over 3 years with 36 patients in whom emergent ECHO was used as part of their initial work-up. Injuries included single stab wounds (17), multiple stab wounds (14), and gunshot wounds (5). Four patients (11%) had jugular venous distention, and 12 (33%) were tachycardic. None had a systolic blood pressure below 90 mm Hg. Four ECHOs (11%) were positive for pericardial effusion. No valvular abnormalities were detected. Three of the effusions were small and these patients were triaged to monitored beds and observed. All three effusions resolved on serial echocardiography. The fourth patient underwent an uneventful operative repair of a left ventricular laceration. Although the yield is low, emergent 2-D ECHO is a valuable tool in the triage of stable penetrating trauma patients when cardiac injury is suspected. Patients without effusion can be discharged or triaged to a ward bed. Small effusions can be observed in a monitored setting with serial examinations, while large effusions should be treated surgically. Echocardiography is less expensive than ICU admission and less invasive than either subxiphoid window or thoracotomy. There are no known complications associated with the procedure and it is recommended for emergent use when available.
Mechanisms involved in the response to prolonged infusion of atrial natriuretic factor in patients with chronic heart failure. We examined the mechanisms involved in the cardiovascular and renal response to prolonged infusion of atrial natriuretic factor (ANF) in patients with chronic heart failure. ANF infusion was titrated to produce a 30% decrease in pulmonary capillary wedge pressure or a 20% increase in cardiac output, and this dose (average, 75 +/- 4 ng/kg/min) was then administered for 20 hours. The short-term response to ANF included significant reductions in central filling pressures, increases in cardiac output, modest increases in diuresis and glomerular filtration rates, significant reduction in plasma aldosterone levels, and a 3.6-fold increase in plasma cyclic GMP levels. During prolonged infusion, plasma cGMP levels and cardiac output gradually returned to baseline. Similarly, the initially increased diuretic effects were completely abolished during prolonged ANF infusion, although plasma alpha-hANF levels remained consistently elevated above baseline values (control, 198 +/- 38; titration, 2,760 +/- 596; 20 hours, 3,499 +/- 659 pg/ml). Four hours after beginning the ANF infusion, marked increases in hematocrit levels were noted (42.5 +/- 1.0% versus 45.3 +/- 1.4%, control and infusion, respectively, p less than 0.05); during this time, no change in total plasma protein concentration occurred, indicating extravascular shift of fluid and plasma proteins. No evidence was noted for activation of vasoconstrictor hormones during prolonged ANF infusion, although mean arterial pressure was significantly reduced throughout the infusion period. Plasma pro-ANF (31-67) levels, determined as a marker for endogenous ANF secretion, were significantly suppressed as were the reductions of central filling pressures. After ANF discontinuation, heart rate and pulmonary capillary wedge pressure increased significantly above baseline values without evidence for sympathetic stimulation. We conclude that 1) prolonged infusion of ANF causes only transient increases in plasma cGMP levels but a sustained reduction of the cardiac release of ANF and that 2) the beneficial hemodynamic effects of ANF, that is, unloading of the ventricles, may be associated with or, in part, may be secondary to a shift of plasma constituents into the extravascular space. The latter may limit the therapeutic potential of ANF for long-term treatment.
Rhodococcus equi infection in the patient with AIDS: literature review and report of an unusual case. Rhodococcus equi is an aerobic, intracellular, gram-positive rod-coccus that is partially acid fast. The organism is primarily a pathogen in animals and has only rarely been seen in immunocompromised humans. Its most common manifestation is a slowly progressive pneumonia that may cavitate. Infections are thought to be acquired via respiratory exposure to animals or soil. R. equi infections are difficult to treat, usually requiring prolonged administration of parenteral antibiotics and often necessitating surgical drainage. A case of cavitary pneumonia and recurrent bacteremia with R. equi in a patient with AIDS is reported, and the current literature on R. equi infections in humans is reviewed.
Cognitive laboratory approach to designing questionnaires for surveys of the elderly. Data from surveys of the elderly are used by policy analysts to design health services programs. Consequently, the quality of survey data on elderly respondents has important implications for this growing segment of society: improving the quality of data should result in more cost effective programs for the elderly. However, studies suggest that the quality of responses from the elderly may be less than that for other respondents. Moreover, the increasing needs of policy analysts and health researchers for data have resulted in more complex survey questions that place a high cognitive burden on respondents. New methods for improving the design of these questionnaires are needed. This project investigated whether new techniques of questionnaire design, adapted from the theories and methods of cognitive psychology, could be effectively used in interviewing older respondents. The techniques used in this study, concurrent think-aloud interviews with followup probe questions, have been shown recently to be effective with younger respondents. Problems that elderly respondents have in comprehending survey questions, retrieving relevant information from memory, and using decision processes to estimate and provide answers were investigated. Questions on functional ability and social support were taken from the 1984 Supplement on Aging to the National Health Interview Survey. Analysis of respondents' think-aloud protocols and responses to probes suggest that the cognitive interview procedures were effective in identifying problems with the survey questions that would result in data of poorer quality and in suggesting the wording of questions that would be likely to result in answers of greater validity and reliability. Implications of these results for survey design and validation studies are discussed.
Prophylactic sclerotherapy for esophageal varices in men with alcoholic liver disease. A randomized, single-blind, multicenter clinical trial. The Veterans Affairs Cooperative Variceal Sclerotherapy Group. BACKGROUND. Sclerotherapy is an effective treatment for bleeding esophageal varices in patients with alcoholic liver disease. It has also been suggested that sclerotherapy might be effective in preventing initial episodes of bleeding and improving survival among such patients. METHODS. We conducted a prospective, randomized trial comparing prophylactic sclerotherapy and sham therapy in 281 men with alcoholic liver disease who had at least three variceal channels and no history of variceal bleeding. All the patients underwent endoscopy; 143 received sclerotherapy, and 138 received sham therapy. RESULTS. The two patient groups were well matched at entry with respect to the extent of liver disease and other clinical indexes, except that other medical illnesses were significantly more common in the sclerotherapy group. The study's data-monitoring board terminated the trial 22.5 months after it began because the rate of mortality from all causes was significantly higher in the sclerotherapy group (32.2 percent) than in the sham-therapy group (17.4 percent, P = 0.004), despite the fact that the men who received sclerotherapy had significantly fewer episodes of esophageal variceal bleeding. The causes of death varied, and there is no obvious explanation for the excess mortality in the sclerotherapy group. After the termination of treatment, the excess mortality rate in the sclerotherapy group promptly declined. There were 53 episodes of upper gastrointestinal bleeding (including 10 from esophageal varices and 9 from esophageal ulcers) in the sclerotherapy group and 40 episodes (including 19 from esophageal varices) in the sham-therapy group. Complications of sclerotherapy were frequent but seldom life-threatening. CONCLUSIONS. For unknown reasons, prophylactic sclerotherapy is associated with increased mortality among men with moderate-to-severe alcoholic liver disease and esophageal varices. Sclerotherapy should not be performed until after an initial episode of bleeding from esophageal varices has occurred.
Laparoscopic cholecystectomy. This article describes the first 50 laparoscopic cholecystectomies emphasizing the two-handed technique that is currently used at Marietta Surgical Center, Marietta, Georgia. This procedure has become primarily an outpatient procedure with resumption of normal activities in 7 days (including athletics). Two patients in this series had complications. One patients was converted to an open procedure because of a common duct injury. The other patient developed a biloma 2 weeks following surgery and recovered uneventfully following paracentesis on an outpatient basis.
Doppler echocardiographic evaluation of diastolic dysfunction. Recently, considerable effort has been directed toward the application of Doppler methods for detecting diastolic dysfunction. Recordings of transmitral filling velocity as obtained from pulsed-wave Doppler have been extensively investigated as a noninvasive method for determining left ventricular diastolic filling properties. Although Doppler parameters appear to reflect volumetric transmitral flow, close correlations with invasive descriptors of diastolic performance have not been found. Furthermore, Doppler transmitral velocities are sensitive to changes in ventricular preload, afterload, and heart rate. However, at least two distinct Doppler spectral patterns have been identified that are associated with impaired ventricular relaxation and restrictive physiology. Thus, Doppler recordings have proven to be of value in identifying the presence and type of diastolic dysfunction, and in the future they may be helpful in following the response to therapeutic interventions. The purpose of this paper is to review the available information relating Doppler transmitral recordings with catheterization and clinical descriptors of diastolic function. Additionally, the aim is to provide an understanding of the value and limitations of these noninvasive measurements in identifying and treating patients with diastolic abnormalities.
Feeding strategies for the dysphagic patient: a nursing perspective. The goal of treatment for the dysphagic patient is to maintain safe oral feeding. Achieving this goal requires an individualized care plan using selected feeding strategies. This care plan will need to be altered as changes in the patient's condition occur.
Fibreoptic bronchoscopy without general anaesthetic. We have used flexible fibreoptic bronchoscopy using sedation and local anaesthesia in 50 children aged 2-19 years (median 10) using an Olympus BFP20 instrument. Indications were opportunistic pneumonias (n = 11), persistent atelectasis (n = 11), recurrent pneumonia (n = 7), miscellaneous lower airway disease (n = 7), recurrent wheezing (n = 3), haemoptysis (3), to diagnose infection or rejection of heart-lung transplants (n = 3), stridor (n = 2), suspected airway compression (n = 1), evaluation of tracheostomy (n = 1), and suspected foreign body (n = 1). In 43 cases (86%) the diagnosis was related to the primary indication. In five (10%) unrelated abnormalities were found, and five (10%) were normal. In 13 (26%) treatment was altered as a result of flexible fibreoptic bronchoscopy. Complications were transient respiratory arrest (n = 2), hypoxia (n = 2), pneumonia (n = 2), and laryngospasm (n = 1). All complications were followed by complete recovery. Our results suggest that flexible fibreoptic bronchoscopy is safe. Advantages over rigid bronchoscopy include greater visual range, fewer complications, and the avoidance of a general anaesthetic. Though invasive it can yield important diagnostic and therapeutic information.
Characterization of an insulin-like growth factor binding protein (IGFBP-4) produced by the B104 rat neuronal cell line: chemical and biological properties and differential synthesis by sublines. A previous report from our laboratory described an approximately 30 kilodalton (kDa) insulin-like growth factor binding protein (IGFBP) that inhibited the binding of insulin-like growth factor I (IGF-I) by its receptor and was secreted by a subline of the B104 rat neuronal cell line. To better understand the biology of this IGFBP, it was purified from media conditioned by these B104 cells, and the chemical and biological properties of the protein were examined. The IGFBP existed as a 24 kDa form and a 28 kDa form when the conditioned media were analyzed by ligand blot. Deglycosylation studies indicated the 28 kDa species was the N-linked glycosylated form of the 24 kDa IGFBP. Multiple forms at both mol wts were found using two-dimensional electrophoresis, suggesting that there were posttranslational modifications in addition to glycosylation. The amino acid sequence of the 12 amino-terminal residues was identical to that of rat IGFBP-4. Increased synthesis of IGFBP-4 by the subline contrasted with neglible production by other B104 cells. Blot hybridization with rat IGFBP-4 complementary DNA showed differential expression of a 2.6 kilobase transcript among B104 cell lines that correlated with quantities of IGFBP-4 secreted in media. The difference persisted even when the cells were xenografted into athymic nude mice. Purified IGFBP-4 inhibited the binding of [125I]IGF-I by its receptor and blunted stimulation of [3H]thymidine incorporation by IGF-I. These findings suggest a role for IGFBP-4 in neural cell function and indicate the B104 cell lines may be a useful model for further examination of IGFBP-4 biology.