shukoor65/lab-rag-model huggingface dataset:
Patterns of DNA-ploidy in operable colorectal carcinoma: a prospective study of 100 cases. A prospective study of cellular DNA content was made by means of flow cytometry in a nonconsecutive series of 100 patients undergoing surgery for primary colorectal adenocarcinoma. DNA-aneuploidy was present in 80% of cases (80/100); 39% of these were multiclonal (31/80). There was no significant correlation between DNA-ploidy and the clinical and pathological features examined, except for the primary tumor site (right colon vs. left colon vs. rectum: P less than 0.001). After a minimum follow-up of 30 months, out of 40 patients with no local invasion and/or distant metastases, 100% (9/9) of those with DNA-diploid neoplasias showed no signs of disease relapse, vs. 55% (17/31) of the DNA-aneuploid cases (P less than 0.05). Furthermore, in 45 cases with a minimum follow-up of 30 months, overall survival was 90% in patients with DNA-diploid carcinomas and 43% in the DNA-aneuploid cases (P less than 0.05).
Neutrophil apoptosis and clearance from neonatal lungs. 8 newborn babies with airways inflammation, who were mechanically ventilated, underwent bronchoalveolar lavage to examine the fate of neutrophils in the inflamed airways. Light microscopy and electronmicroscopy showed evidence of neutrophil apoptosis and ingestion of intact neutrophils by macrophages in specimens from all 8 infants. Neutrophil apoptosis, without the local release of intracellular contents that promote inflammation, might represent a mechanism by which tissue injury is reduced during the resolution of neonatal pulmonary inflammation.
Sixth nerve schwannomas. Report of two cases. Two cases of sixth cranial nerve schwannoma are presented with a review of four other cases from the literature. The clinical spectrum, neuroradiological findings, and surgical outcome of the six cases are discussed. There are two distinct clinical presentations for sixth cranial nerve schwannomas. Type I sixth nerve schwannomas present with sixth nerve palsy and diplopia and arise from the cavernous sinus. In contrast, type II sixth nerve schwannomas have a more severe presentation with obstructive hydrocephalus, raised intracranial pressure, sixth nerve palsy, and diplopia. This type arises along the course of the sixth cranial nerve in the prepontine area. Cavernous sinus involvement in either type may preclude total surgical excision and indicate an increase possibility for recurrence.
The role of extrapleural pneumonectomy in malignant pleural mesothelioma. A Lung Cancer Study Group trial Malignant pleural mesothelioma is usually a fatal cancer for which operation has been the mainstay of treatment because chemotherapy and radiation are relatively ineffective. The choice of operation for malignant pleural mesothelioma remains controversial. Extrapleural pneumonectomy has been advocated because it allows complete removal of gross tumor and can be associated with long-term survival. To evaluate extrapleural pneumonectomy, we conducted a prospective multiinstitutional trial in patients with biopsy-proved previously untreated malignant pleural mesothelioma. Criteria for extrapleural pneumonectomy were (1) potentially completely resectable unilateral disease by computed tomography scan, (2) predicted postresection forced expiratory volume in 1 second greater than 1 L/sec, and (3) no other major medical problems. Patients who were not candidates for extrapleural pneumonectomy had a more limited operation with or without adjuvant therapy or had nonsurgical treatment. From September 1985 to June 1988 83 eligible patients (64 male, 19 female) were entered. The mean age for all patients was 59.7 years. Only 20 of the 83 patients (24%) underwent extrapleural pneumonectomy. Three of these 20 patients (15%) died postoperatively. The recurrence-free survival was significantly longer for the patients undergoing extrapleural pneumonectomy than for the other two groups (p = 0.03), but there was no difference in overall survival among the three groups. In univariate analyses, epithelial versus sarcomatoid and mixed histologic findings and platelet count less than 400,000 were associated with a better overall survival (p = 0.02), and performance status (Karnofsky less than 80) was predictive of recurrence (p = 0.02). In a multivariate analysis, histologic findings, sex, age, extrapleural pneumonectomy, weight loss, and performance status all had no significant impact on survival. Extrapleural pneumonectomy was associated with a greater likelihood of relapse in distant sites than were limited operation and nonsurgical treatment. We conclude that (1) only a small proportion of all patients with malignant pleural mesothelioma are candidates for extrapleural pneumonectomy, (2) extrapleural pneumonectomy carries a significant operative mortality and does not seem to improve overall survival compared with more conservative forms of treatment, (3) extrapleural pneumonectomy alters the patterns of relapse, and (4) factors previously thought to have an impact on survival in other series did not affect outcome in this trial.
Management of acute retention of urine: a reappraisal. Our standard policy for the management of retention of urine due to prostatic hypertrophy is that the patient is catheterised and sent home, later to be seen and assessed in the Out-patient Department where he is given an admission date for operation. A detailed audit of 166 patients cared for in this way is presented and the results compared with those in 25 patients who remained in hospital in the interval between catheterisation and operation and in 402 patients not previously catheterised. Although the mortality rate was significantly higher in the retention group (3.3 vs 0.25%), we feel that this is a reflection of the fitness of the patients with retention rather than a consequence of the management policy. The advantages of the "catheterise and send home" policy are discussed.
Ruptured saccular aneurysm associated with duplication of the vertebral artery. A case of a ruptured aneurysm arising from a duplicated segment of the intracranial portion of the vertebral artery is reported. This particular association, which can be explained by the embryological development of the vertebral artery, has not been described previously.
The use of bone allografts for limb salvage in high-grade extremity osteosarcoma. Limb preservation is increasingly being employed in the local treatment of high-grade extremity osteosarcoma. Bone allografts used to reconstruct the bony defects following tumor resection offer many advantages, including joint reconstruction and incorporation of the graft to the host bone in these relatively young patients. The results of 53 patients 30 years of age or younger were assessed to determine functional outcome. Fresh-frozen allografts were employed as osteoarticular grafts, allograft-arthrodeses, allograft-prosthesis composites, or intercalary grafts. Follow-up intervals averaged 25 months (range, two to 63 months). Life-table analysis showed that the probability of a satisfactory functional result was 73% if local tumor recurrences were excluded. Complications included 16 infections, six fractures, 12 nonunions, and six unstable joints. There were five local recurrences. Eighteen grafts ultimately failed, and in six patients, this resulted in an above-knee amputation. An additional five received a second graft. The functional "end results" of the 38 patients with two or more years of follow-up examinations were 70% satisfactory in those without a local recurrence. There was no statistically significant difference in functional outcome or local or distant relapse in those patients receiving preoperative chemotherapy. The authors conclude that allografts can be used for limb reconstruction in patients with high-grade osteosarcoma who receive aggressive adjuvant chemotherapy. The functional results are comparable to other methods of reconstruction, and once incorporated by the host, offer the advantage of longevity, compared with metallic implants.
Physiological analysis of simple rapid movements in patients with cerebellar deficits. Patients with cerebellar deficits made elbow flexion movements as rapidly as possible for three different angular distances. Electromyographic activity of biceps and triceps and the kinematics of the movements were analysed. Results were compared with those of normal subjects making both rapid and slow movements. In the patients, the first agonist burst of the biceps was frequently prolonged regardless of the distance or speed of the movement. The most striking kinematic abnormality was prolonged acceleration time. The pattern of acceleration time exceeding deceleration time was common in patients but uncommon in normal subjects. The best kinematic correlate of the duration of the first agonist burst was acceleration time. Altered production of appropriate acceleration may therefore be an important abnormality in cerebellar dysfunction for attempted rapid voluntary movements.
Treatment failure of genital condylomata acuminata in women: role of the male sexual partner. The male sexual partners of women with genital condylomata acuminata are thought to be carriers of human papillomaviruses. It is therefore often recommended that both sexual partners be treated. We studied 360 women with genital warts to test the hypothesis that when the male partners of women with condylomata acuminata are treated, the treatment failure rate decreases. The male sexual partners of 180 of these women were examined and, if indicated, treated (treatment group). The 180 remaining male sexual partners were neither examined nor treated (control group). One hundred twenty-two (68%) men in the treatment group had human papillomavirus-associated lesions. The treatment failure rate of women was 16.7% in the treatment group and 18.9% in the control group. The difference is not statistically significant (p greater than 0.05). The results of this study do not support the hypothesis that the treatment failure rate of women with condylomata acuminata decreases if their male sexual partners are also treated.
Visual impairment and cognitive dysfunction in Alzheimer's disease. OBJECTIVE: To determine whether impaired visual acuity is associated with dementia and cognitive dysfunction in older adults. DESIGN: Paired case-control comparisons of the relative frequencies of visual impairment in demented cases and nondemented controls. Cohort analyses of correlation between visual acuity and cognitive functioning in demented cases. SETTING: Internal medicine clinics at two academically affiliated medical centers. PARTICIPANTS: Eighty-seven consecutively selected patients greater than or equal to 65 years of age with mild-to-moderate, clinically diagnosed Alzheimer's disease (cases) and 87 nondemented controls matched to the cases by age, sex, and education. MEASUREMENTS AND MAIN RESULTS: The prevalence of visual impairment was higher in cases than in controls [unadjusted odds ratio for near-vision impairment = 2.7 (95% CI = 1.4, 5.2); unadjusted odds ratio for far-vision impairment = 2.1 (95% CI = 1.02, 4.3); odds ratios adjusted for family history of dementia, depression, number of medications, and hearing loss were 2.5 (95% CI = 1.1, 10.5) for near-vision impairment and 1.9 (95% CI = 0.8, 4.6) for far-vision impairment]. When further stratified by quartiles of visual acuity, no statistically significant "dose-response" relationship between vision impairment and dementia risk was observed. Among cases, the degree of visual impairment was significantly correlated with the severity of cognitive dysfunction for both near and far vision (adjusted ps less than 0.001). CONCLUSIONS: Visual impairment is associated with both an increased risk and an increased clinical severity of Alzheimer's disease, but the increased risk may not be consistent with a progressive dose-response relationship. Further studies are needed to determine whether visual impairment unmasks and exacerbates the symptoms of dementia or is a marker of disease severity.
Maternally inherited myopathy and cardiomyopathy: association with mutation in mitochondrial DNA tRNA(Leu)(UUR). Different point mutations of the mitochondrial genome, which all affect the ability of mitochondria to translate their own genes and lead to partial defects of mtDNA-dependent respiratory complexes, are related to distinct clinical mitochondrial disorders. A new maternally inherited disorder, characterised by a combination of adult-onset myopathy and cardiomyopathy, with no clinical involvement of the nervous system, was found in members of a single large pedigree. A heteroplasmic new mutation was identified in the mtDNA gene specifying tRNA(Leu)(UUR). This mutation segregated specifically with the disorder, and there were significant correlations between the proportion of the mtDNA that was of the mutant form and the activities (normalised for citrate synthase activity) of the two mtDNA-dependent respiratory enzymes (complex I, r = -0.71, p less than 0.005: complex IV r = -0.77, p less than 0.005) and the maximum oxygen consumption (r = -0.82, p less than 0.005), a physiological index of aerobic metabolism. These findings strongly suggest that the tRNA(Leu)(UUR) mutation is the genetic cause of this disorder, and that lesions of mtDNA should be considered in the differential diagnosis of the hereditary cardiomyopathies.
Selective attenuation by perivascular blood of prostanoid-dependent cerebrovascular dilation in piglets. Cerebral hemorrhagic insults are common in neonates. However, the consequences of intracranial blood on cerebral hemodynamics are poorly understood. We examined the effects of perivascular blood on cerebrovascular dilator responses in 29 piglets. Fresh, autologous blood (n = 15) or cerebrospinal fluid (n = 14) was placed under the dura mater over the parietal cortex, and the piglets were allowed to recover from anesthesia. One to four days later, a closed cranial window was placed over the parietal cortex and pial arteriolar responses to arterial hypercapnia (PaCO2 greater than 55 mm Hg), hemorrhagic hypotension (mean arterial blood pressure less than 35 mm Hg), or topical application of 10(-6) and 10(-4) M isoproterenol were determined. Pial arterioles in the cerebrospinal fluid group dilated 27 +/- 4% (mean +/- SEM) (n = 11) in response to hypercapnia, 26 +/- 5% (n = 9) in response to hypotension, and 26 +/- 3% in response to 10(-6) M and 40 +/- 4% in response to 10(-4) M isoproterenol (n = 11). In the group in which blood was placed on the parietal cortex, pial arterioles did not dilate significantly in response to hypercapnia (8 +/- 3%, n = 11) or hypotension (2 +/- 5%, n = 13) but dilated normally in response to isoproterenol (25 +/- 5% in response to 10(-6) M and 36 +/- 7% in response to 10(-4) M, n = 13). We conclude that prolonged contact of pial arterioles with extravascular blood selectively attenuates cerebrovascular dilation in piglets.
Prevalence of coronary risk factors in elderly blacks and whites. Coronary risk factors were determined in a prospective study of 1,414 elderly persons (999 women and 415 men), mean age 82 +/- 8 years. Of 1,414 persons, 215 (15%) were black and 1,140 (81%) were white. The prevalences of cigarette smoking, hypercholesterolemia, low serum high-density lipoprotein cholesterol, and increased serum total cholesterol/high-density lipoprotein cholesterol ratio were not significantly different in elderly blacks and whites. Elderly blacks had a higher prevalence of hypertension (50% versus 36%, P less than 0.001), diabetes mellitus (27% versus 19%, P less than 0.01), and obesity (11% versus 5%, P less than 0.005) and a lower prevalence of hypertriglyceridemia (9% versus 15%, P less than 0.05) than elderly whites. In elderly persons with hypertension, electrocardiographic left ventricular hypertrophy occurred in 19% of blacks and 14% of whites (P not significant), echocardiographic left ventricular hypertrophy occurred in 72% of blacks and 56% of whites (P less than 0.01), and concentric left ventricular hypertrophy occurred in 60% of blacks and 39% of whites (P less than 0.001).
Pain management. Patients with pain are not a new phenomena. For centuries, the incidence of pain has been well-documented. Responsibility for pain management has not been a universal priority for health care providers; however, pain management must be considered an integral part of the nursing role. The health care system must facilitate the improved management of patient's pain. A better understanding of the factors that underpin the effective management of a patient's pain is necessary. In this article, the theoretical foundation and conceptual model used in the expansion of this knowledge is presented. Further, the physiologic and pharmacologic principles related to this patient care issue are discussed. Appropriate consideration of the nurse's significant part in the management of pain is emphasized.
Interrupting the adaptive changes in congestive heart failure. Circulating plasma concentrations of norepinephrine, renin, angiotensin and vasopressin are increased in congestive heart failure. By increasing ventricular afterload, heart failure is further worsened, which in turn--in a vicious cycle--stimulates neurohumoral vasoconstrictor mechanisms. Furthermore, because of the compensatory but excessive stimulation of the sympathomimetic system, a down-regulation and desensitization particularly of the myocardial beta 1 receptors and depletion of myocardial catecholamine occurs in chronic heart failure. These defects may be restored toward normal by interventions that attenuate the activity of the sympathetic nervous system. A direct approach to modify the excessive vasoconstriction is to administer systemic vasodilator drugs, but despite favorable short-term effects, tolerance developed to most of these drugs during long-term treatment. One reason for the loss of effectiveness is the reflex activation of the sympathetic system, which increases vasoconstrictor hormone concentrations. Activation of the renin-angiotensin system can be modified effectively by angiotensin-converting enzyme inhibitors that have shown favorable responses in patients with chronic heart failure. Beta-blocking agents interfere with endogenous sympathetic activation and have produced beneficial effects in patients with congestive cardiomyopathy. Long-term treatment is associated with up-regulation of the number of beta receptors and an improved responsiveness to catecholamines. Owing to the negative inotropic effects of beta-blocking agents, some of the patients with severe heart failure deteriorated hemodynamically and clinically. Theoretically, it should be advantageous to have a substance that combines protection against excessive beta stimulation with a mild inotropic support to prevent cardiac decompensation. This may be achieved by a selective beta 1-partial agonist like xamoterol.
The relative value of consultation, questionnaires and laboratory investigation in the identification of excessive alcohol consumption. Alcohol is a major cause of morbidity and mortality in Britain. Consultation, questionnaires and laboratory tests may all be used to help identify alcohol abuse and thereby prevent and treat alcohol-related problems. Consultation which can identify 80% of alcohol abusers involves recording the findings of alcohol and general histories and physical examination. The accuracy of the assessment depends on the reliability of the respondent and the respondent's relations and friends, and on the skill of the investigator; however, thorough assessment is time-consuming and expensive. Questionnaires may identify up to 80% of alcoholics. They are generally based on the Michigan Alcohol Screening Test and CAGE questionnaires and are simple, rapid to complete, inexpensive and not dependent on skilled investigators; however, the principal disadvantage of using questionnaires is that a personal relationship is not developed with the subject. Finally, simple and complex laboratory tests may be used. Of the simple laboratory tests, raised GGT or MCV levels are the most useful and when these values are combined, 90% of alcoholics may be identified correctly. Complex laboratory tests may exhibit greater sensitivity and specificity and provide useful additional information; however, their restricted availability limits their widespread use. The value of each of these methods depends on the objective of the assessment. For population surveys, questionnaires are of greatest relative value and consultation and laboratory tests may be used to confirm the presence of alcohol abuse. In general practice and the hospital setting, it is imperative to include questions on alcohol intake and alcohol-related problems in all interviews with patients. Laboratory tests may be used to confirm suspected alcohol abuse and questionnaires may provide useful screening tools. Finally, in the specialist alcohol unit, consultation, questionnaires and laboratory investigations are all important for identifying alcohol abuse. In this setting, consultation is of particular importance and the alcohol history and physical examination should be recorded by a skilled investigator and the results confirmed with relatives and close friends. Questionnaires are useful as initial screening or assessment tools and computer-based systems may facilitate data collection. Simple and complex laboratory tests may be used to confirm the diagnosis and help ascertain the extent of disease. By assuming that 'all patients have alcohol-related problems until proven otherwise', and through the appropriate application of consultation, questionnaires and laboratory tests, identification of excessive alcohol consumption and the prevention of its sequelae will be facilitated.
Healing of erosive esophagitis with sucralfate and cimetidine: influence of pretreatment lower esophageal sphincter pressure and serum pepsinogen I levels. Forty-eight patients with erosive reflux esophagitis were allocated to either sucralfate tablets, 4 g/day, or cimetidine, 1.6 g/day, for 8 weeks in a randomized, prospective, single-blind, cross-over therapeutic trial. Pretreatment lower esophageal sphincter (LES) pressure and serum pepsinogen I (PG-I) levels were investigated as possible predictors of healing with either drug. The trial was completed by 41 patients (21 in the sucralfate group and 20 in the cimetidine group); one patient in each group was removed because of side effects. Symptom improvement occurred to a similar extent in both groups. Endoscopic results after 8 weeks of treatment with sucralfate revealed complete healing of esophageal erosions in 48% (cimetidine, 55%) and improvement in an additional 19% (cimetidine, 20%). Neither of these differences was statistically significant. Some patients refractory to one drug had endoscopic healing of esophagitis when treated with the other drug after crossover. LES pressure did not influence outcome in patients treated with sucralfate, whereas significantly (p = 0.024) more patients refractory to cimetidine had an LES pressure less than 7 mm Hg than did those with a good response to the histamine-2 (H2)-receptor blockade. Patients whose esophagitis healed or improved after sucralfate tended to have lower serum PG-I levels than those with treatment failure (104 +/- 35 ng/mL vs 125 +/- 45 ng/mL), whereas the opposite occurred in patients treated with cimetidine (132 +/- 58 ng/mL in responders vs 78 +/- 27 ng/mL in nonresponders, p = 0.048). The results confirm that sucralfate is a valuable alternative to H2-receptor inhibitors for the treatment of reflux esophagitis. They also provide preliminary evidence that LES pressures and serum PG-I levels may have predictive value of the response to one or the other of these two drugs.