shukoor65/lab-rag-model huggingface dataset:
Macrophage apolipoprotein synthesis and endoneurial distribution as a response to segmental demyelination. The synthesis and endoneurial distribution of apolipoproteins in response to myelin degradation was elucidated morphologically and biochemically in rodent models of segmental demyelination. At the onset of acute demyelination induced by tellurium (Te) poisoning, macrophages infiltrated the endoneurium and then began to express cytoplasmic immunoreactivity for apolipoprotein E (apo E). When demyelinating nerve slices were incubated with S35-methionine, radiolabeled apo E was released, showing that apo E was actively synthesized by the macrophages. Macrophages secreted apo E into the endoneurial spaces, leading to dense endoneurial accumulations. Other apolipoproteins (apo A1 and albumin) were not synthesized in the endoneurium, but they entered edematous nerves, presumably through an early breakdown in the blood-nerve barrier. During the phagocytosis of myelin, plasma-derived apolipoproteins accumulated within some of the macrophages. In chronic demyelination caused by lead poisoning, the cellular and extracellular distribution of apolipoproteins was similar to Te neuropathy; the amount of apo E accumulation and the macrophage density were proportional to the prevalence of active demyelination in teased fibers. Similar patterns of endoneurial apo E were present in an inherited form of demyelination in the twitcher mouse, after antibody-mediated demyelination, and in demyelination secondary to axonal degeneration. Human sural nerve biopsies had patterns of apolipoprotein E antigenicity that were comparable to the rodent models. We conclude that secretion of apo E by infiltrating macrophages is a generalized response to demyelination, and that endoneurial edema leads to the accumulation of certain plasma apolipoproteins within macrophages. These data suggest that endoneurial apolipoproteins and macrophages might mediate important functions in patients recovering from primary and secondary demyelination.
Daily chronic headache. Headache is a disabling condition, and medical science has not, until recently, begun to address it in a fashion consistent with its widespread impact. Despite the limitations in our current understanding, as well as the historical prejudice directed toward patients with this condition, current understanding and treatment approaches can provide hope and relief for most patients who have these disorders.
Bilateral retinal hamartomas in neurofibromatosis type 2. We report a case of bilateral retinal hamartomas in a child with neurofibromatosis type 2. This unique case demonstrates that a diversity of retinal changes can occur in this disease.
Prevalence and severity of morbidity among Gujarati Asian elders: a controlled comparison. Asian elders make relatively heavy use of health services: this may be due to higher levels of morbidity, but controlled comparisons have not been carried out. A comparison of the prevalence and severity of chronic diseases and use of health services of Asian and indigenous elders was made. A sample of 59 Gujarati Asians of mean age 62.9 years and 59 indigenous subjects of mean age 63.9 years of whom 42% (25 in each group) were female drawn from a general practice was studied. Asian subjects had a higher prevalence of diagnosed diseases, with the exception of chronic obstructive airways disease, but lower risk of falls and urinary incontinence. Asian subjects had higher life satisfaction scores and lower prevalence of depressed mood. Asian women were more likely to have had contact with primary care services. Both Asian men and women had more frequent hospital admissions, but similar levels of out-patient attendance. Body mass index, blood pressure and shoulder joint range of movement were similar for both Asians and the indigenous population. Asian subjects had significantly lower peak expiratory flow rates and hand grip strength. Asian elders have a higher risk of chronic diseases, but the impact of disease (indicated by life satisfaction, mood, and common disabilities) is less than among the indigenous population. Lower peak expiratory flow rates and grip strength among Asian elders are of concern since they may lead to premature arrival at age-related thresholds of physical capacity essential for independence in activities of daily living.
Why all placentas should be examined by a pathologist in 1990 Placental pathology is rarely a part of the training for either obstetrician or pathologist. As a result there has been confusion regarding the potential benefits of routine placental examination. These benefits include clarification of the causes of many adverse pregnancy outcomes, improvement of the risk assessment for future pregnancies, and ascertainment of newborn risk for long-term neurodevelopment sequelae. Information on placental abnormalities may reveal the presence of chronic fetal insults and allow their differentiation from acute (peripartum) stresses. Current methods of risk assessment fail to identify the majority of pregnancies that end in prematurity, stillbirth, growth retardation, or fetal distress. We suggest that placental pathology should be a routine component of obstetric-neonatal care.
Gaze-dependent hemianopia without hemispatial neglect. A hemispheric field is the space defined by the midsagittal plane of the body. Hemianopia, in the absence of hemispheric spatial neglect, has been thought to be purely retinotopic. Confrontation testing of visual fields in eccentric positions of gaze in hemianopic patients permits the discrimination of hemispheric from retinotopic deficits. In the primary position of gaze, a patient with an ischemic lesion of the right occipital and temporal lobes, who was without unilateral spatial neglect, was unable to detect finger movement, name objects, or identify shapes or colors in the left retinotopic hemifield, but when gazing 30 degrees to the right (so that the left retinotopic field was in the right hemispheric field), he performed nearly as well in the left retinotopic field as in the right. The mechanism of this gaze-dependent hemifield visual impairment is unknown, but we discuss four possibilities: (1) eccentric gaze enhances an alternative visual system; (2) the lesion led to modality-specific hemispheric inattention that was corrected by directing intention (plan to act) and gazing to the right; (3) the lesion led to modality specific inattention that was corrected by compensatory mechanisms that may normally enhance attentive vigilance in central space during eccentric gaze; and (4) the neuronal substrate for hemispheric vision was destroyed, whereas that for retinotopic vision was preserved.
Coronary heart disease risk markers in users of low-dose oral contraceptives. Seven combination oral contraceptives (OCs) were studied for their effects on glucose, insulin, triglyceride and lipoprotein concentrations. Subjects included 925 women using fixed-dose (monophasic) or variable-dose (triphasic) formulations and 418 premenopausal women not using OCs. The monophasics contained 150 or 250 micrograms of levonorgestrel, 500 or 1,000 micrograms of norethindrone or 150 micrograms of desogestrel as the progestin. Triphasic progestin doses were 50-125 micrograms of levonorgestrel or 500-1,000 micrograms of norethindrone. All the formulations increased the fasting serum triglycerides. No changes were seen in serum total cholesterol. The effects on serum lipoproteins depended on the progestin type and dose. Monophasics containing 500 micrograms of norethindrone or 150 micrograms of desogestrel lowered low density lipoprotein (LDL) cholesterol and increased high density lipoprotein (HDL) cholesterol. Monophasics containing levonorgestrel reduced HDL cholesterol. The triphasics did not affect LDL or HDL cholesterol but altered the balance of HDL subfractions. All the formulations caused a deterioration in glucose tolerance and insulin resistance and increased pancreatic insulin secretion. The greatest effects were seen with formulations containing levonorgestrel. The study showed that a reduction in the progestin dose and use of novel progestins can reduce the potentially adverse effects of OCs on metabolic risk markers for coronary heart disease.
Magnetic resonance imaging evaluation of uveal tumors. We detected seven tumors with magnetic resonance imaging, which demonstrate some of the uses and limitations of this diagnostic technique. In one patient, the correct diagnosis of extraocular extension was demonstrated with magnetic resonance imaging when both clinical and ultrasonographic data were not diagnostic. In another case, an extremely small area of extraocular extension was detected with ultrasound evaluation but was not noted on magnetic resonance imaging. Magnetic resonance imaging is highly reliable in the detection of intraocular tumors. In pigmented uveal melanomas it is both sensitive and highly specific. In amelanotic processes magnetic resonance imaging can identify a mass but cannot always adequately characterize it. Further experience will be necessary to determine the proper role of magnetic resonance imaging in the evaluation of uveal tumors.
Socioeconomic status and visual impairment among urban Americans. Baltimore Eye Survey Research Group. The Baltimore Eye Survey is a population-based study of ocular disorders conducted in East Baltimore, Md, designed to determine the prevalence and severity of vision loss and ocular disease and their relationships to socioeconomic and other risk factors. This survey comprised 5300 subjects (2911 whites and 2389 blacks). Visual impairment was associated with age, race, general health status, educational level, income, and employment status. An identified association of race with blindness and visual impairment was reduced, but not eliminated, after adjustment for these socioeconomic factors, indicating that socioeconomic status itself is an important determinant of visual impairment.
Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus. Twelve patients, ranging in age from thirty-four to seventy-two years (average, fifty-three years), were evaluated an average of five years (range, two to eight years) after open reduction and internal fixation of a two-part displaced fracture of the greater tuberosity of the proximal part of the humerus. The indication for operative reduction was one centimeter or more of displacement of the fracture as seen on the diagnostic radiographs. The anterosuperior deltoid-splitting approach, combined with rotation of the humerus, allowed adequate exposure of the retracted tuberosity. Internal fixation of the greater tuberosity with heavy, non-absorbable sutures and careful repair of the rotator cuff permitted early passive motion. All fractures healed without postoperative displacement. Six patients had an excellent result and six had a good result; active elevation averaged 170 degrees. There was one partial, transient palsy of the axillary nerve.
Double-blind placebo-controlled trial of buflomedil in the treatment of Raynaud's phenomenon: six-month follow-up. The efficacy of buflomedil in reducing the mean daily frequency and severity of winter ischemic attacks has been shown in a randomized, double-blind, placebo-controlled trial including 31 patients (16 in the buflomedil group, 15 in the placebo group) suffering from idiopathic Raynaud's phenomenon and followed up for six months. The efficacy was confirmed by nail fold capillaroscopy, which showed a significant alleviation of hemodymanic disturbances and background pallor in comparison with the placebo. Results in terms of clinical and laboratory safety parameters assessed over a six-month period were satisfactory, thus demonstrating the possibility of a long-term treatment.
Review article: migraine and pregnancy. A 27-year-old woman with no family or personal history of migraine presented with headache associated with unilateral paresthesias and blurred vision. This was her first, and so far only, attack of migraine with aura and led to the diagnosis of her pregnancy and to this review. Migraine can begin for the first time with pregnancy, particularly in the first trimester. Cases of migraine with aura are the most commonly reported. Preexisting migraine usually improves with pregnancy, particularly if it was associated with menstrual migraine. Headache occurs frequently in the post-partum period, particularly in known migraineurs. Migraineurs have no increased risk of complications during pregnancy and their children have no increased incidence of birth defects.
Foodborne outbreak of gastroenteritis caused by Escherichia coli O157:H7--North Dakota, 1990. In late July and early August 1990, an outbreak of gastroenteritis occurred among persons who had eaten a meal while attending an agricultural threshing show in North Dakota on July 28-29. At least 70 (3.5%) of the more than 2000 attendees were affected; of these, 16 persons were hospitalized, and two children, aged 2 and 8 years, were diagnosed with hemolytic uremic syndrome. An epidemiologic investigation was conducted by the North Dakota State Department of Health and Consolidated Laboratories.
Kaposi's sarcoma in a patient with rheumatoid arthritis possible responsibility of captopril in the development of lesions. Kaposi's sarcoma appeared 8 months after the start of captopril treatment in a 70-year-old woman with rheumatoid arthritis. A marked reduction of cutaneous and gastric lesions occurred when captopril was stopped. These findings are compared to immunosuppressive drug induced forms of Kaposi's sarcoma.
Non-invasive assessment of perioperative myocardial cell damage by circulating cardiac troponin T. Troponin T is a unique cardiac antigen which is continuously released from infarcting myocardium. Its cardiospecificity as a marker protein might be particularly useful in assessing myocardial cell damage in patients undergoing cardiac surgery. Therefore, circulating troponin T was measured in serial blood samples from 56 patients undergoing cardiac surgery and in two control groups--22 patients undergoing minor orthopaedic surgery and 12 patients undergoing lung surgery by median sternotomy. In both control groups no troponin T could be detected, whereas activities of creatine kinase were raised in all 12 lung surgery controls and activities of the MB isoenzyme were raised in five of the 12 patients in the lung surgery group and in four of the 22 patients in the orthopaedic surgery group, respectively. All the patients undergoing coronary artery bypass grafting (n = 47) and cardiac surgery for other reasons (n = 9) had detectable concentrations of troponin T. Five patients had perioperative myocardial infarction detected as new Q waves and R wave reductions. In these five patients troponin T release persisted and serum concentrations (5.5-23 micrograms/l) reached a peak on the fourth postoperative day. In the 51 patients without perioperative myocardial infarction serum concentrations and the release kinetics of troponin T depended on the duration of cardiac arrest. In patients in whom aortic cross clamping was short troponin T increased slightly on the first postoperative days; in patients with longer periods of aortic cross clamping troponin T concentrations were higher and remained so beyond the fifth postoperative day.
Hemodialysis grafts: color Doppler flow imaging correlated with digital subtraction angiography and functional status. Twenty-two patients with hemodialysis grafts were prospectively evaluated with color Doppler flow imaging and digital subtraction angiography (DSA). Eighteen patients had normal functional parameters during hemodialysis, and four had increased venous pressure during hemodialysis. Color Doppler flow imaging allowed identification of nine macroaneurysms related to wall degeneration, two cases of spontaneous fistula formation between the graft and peripheral veins, and 20 stenoses. Use of color Doppler flow imaging led to overestimation of the degree of stenosis at the venous anastomosis when compared with use of angiography. Three cases of subclavian venous stenosis were identified only at angiography. Color Doppler flow imaging appears accurate in the detection of stenoses and seems sufficient for follow-up of normally functioning grafts. However, because of its low sensitivity for identification of proximal stenoses and the necessity of obtaining an angiogram to plan surgical or percutaneous correction, DSA remains the technique of choice.
Low angiotensinogen levels are related to the severity and liver dysfunction of congestive heart failure: implications for renin measurements. PURPOSE: To compare the determination of plasma renin activity (PRA) and the direct measurement of active renin by immunoradiometric assay (IRMA) as methods of assessing the renin system in patients with congestive heart failure. PATIENTS AND METHODS: The status of the renin-angiotensin system in congestive heart failure was assessed by measuring the plasma renin substrate concentration, PRA, and plasma concentration of active renin in 37 patients with mild to severe congestive heart failure. Natremia and plasma levels of atrial natriuretic factor (ANF) were determined as biologic indexes of the severity of heart failure, and concentrations of prealbumin and retinol-binding protein were used as indexes of liver dysfunction. RESULTS: The PRA and the concentrations of active renin and ANF were markedly higher in patients with New York Heart Association class IV heart failure than in patients with class II to III heart failure, while natremia and the concentrations of renin substrate, prealbumin, and retinol-binding protein were markedly lower in the class IV patients than in the class II to III patients. Plasma renin substrate concentration was negatively correlated with active renin concentration (n = 37, r = -0.45, p = 0.005), and positively related to natremia (r = 0.56, p less than 0.0005), prealbumin (r = 0.54, p less than 0.001), and retinol-binding protein (r = 0.60, p less than 0.0001). CONCLUSIONS: Low levels of plasma renin substrate can be considered as an indirect index of the severity of heart failure that reflects both the high level of circulating active renin and the decrease in hepatic protein output. In patients with class IV heart failure, low levels of renin substrate led to a marked underestimation of active renin concentration from measurements of PRA. In contrast, direct IRMA of active renin measures the true plasma active renin concentration, independent of plasma renin substrate, and closely reflects renin secretion.
Human astrocytes contain two distinct angiotensin receptor subtypes. The ability of angiotensin peptides to stimulate prostaglandin release and raise intracellular calcium levels by activating a phosphoinositide-specific phospholipase C was assessed in three human astrocytoma cell lines (CRTG3, STTG1, and WITG2). The addition of angiotensin II to CRTG3 cells resulted in a dose-dependent release of prostaglandin E2 and prostacyclin, the production of inositol 1,4,5-trisphosphate, and the mobilization of intracellular calcium. Angiotensin-(1-7), previously considered to be an inactive metabolite of angiotensin II, was as potent as angiotensin II for prostaglandin release but did not activate phospholipase C or mobilize intracellular calcium. In contrast, angiotensin-(2-8) caused only a slight increase in prostaglandin release, even though it was as effective as angiotensin II in augmenting inositol 1,4,5-trisphosphate production and calcium mobilization. Moreover, neither the release of prostaglandins in response to angiotensin II or angiotensin-(1-7) nor the mobilization of intracellular calcium in response to angiotensin II required extracellular calcium. Angiotensin II and angiotensin-(1-7) caused the release of prostaglandins from all three human astrocytoma cell lines, but changes in the level of intracellular calcium in response to angiotensin II only occurred in CRTG3 cells. Although previous studies have provided evidence for angiotensin receptor subtypes on the basis of selectivity of antagonists or signal transduction mechanisms, these data suggest that human astrocytes contain multiple angiotensin receptor subtypes on the basis of their response to different angiotensin heptapeptides--angiotensin-(1-7) and angiotensin-(2-8).
Surgical and chemotherapeutic treatment of hepatic metastases from carcinoma of the breast. To date, no five year survival rates have been reported for patients with hepatic metastases (HM) from breast origin treated by chemotherapy or hormone therapy. This study was done to evaluate whether or not surgical excision of such metastatic disease associated with chemotherapy has any effect on such a poor prognosis. Between May 1985 and September 1988, 22 patients with a diagnosis of isolated (solitary or multiple) HM have been surgically treated. The therapeutic approach also included systemic preoperative and postoperative chemotherapy. Laparotomy findings for those 22 patients are presented. There were benign hepatic lesions in four patients (four different histologic types) and hepatectomy was done in two patients. Diffuse metastatic disease contraindicated any attempt at hepatic resection in six patients. Hepatectomy was possible in 12 patients. There was no postoperative mortality and minimal morbidity. One-half of the patients with metastases had one or more positive lymph nodes at the hepatic pedicule. Median survival time for 12 patients treated by hepatectomy was 37 +/- 9 months after hepatectomy and 42 +/- 3 months after the discovery of HM. Eleven patients had other metastases after an average period of 11.8 months after hepatectomy, and the liver was the first site of recurrence in eight. One patient underwent a hepatectomy twice. Two patients were free of disease 29 to 46 months postoperatively in spite of poor prognostic features on the excised specimen. Although the median survival time was two times better than with usual treatment, we believe this procedure is of doubtful benefit. In this situation, hepatectomy acts as cytoreductive surgical treatment, with the main limiting factor being the relatively low effectiveness of chemotherapy. This type of therapy can be applied only to a restricted number of patients, and if we decide to proceed with this study, we will have to modify the protocol of chemotherapy radically.
The Health of the Public Program at the University of Washington: a new role for academic medical centers. The University of Washington Health of the Public Program has convened a consortium composed of the region's academic medical center, the two largest managed care plans in Washington, and representatives of the state's major private and public purchasers of health care. The consortium's purpose is to test the feasibility of collaboratively collecting cross-system data, assessing variations in practice, and implementing site-specific interventions to improve the management of common illnesses and encourage preventive care. Changes under way in the ambulatory training environment and in the undergraduate curriculum as a result of the consortium's initial efforts are described. In today's climate of cost consciousness and concerns about quality, academic medical centers can play an important role in helping to improve community-wide outcomes of care.