shukoor65/lab-rag-model huggingface dataset:
Late follow-up of carotid endarterectomy with venous patch angioplasty. Ninety carotid endarterectomies with venous patch angioplasty were performed in 83 patients between July 1980 and December 1985. The primary indication for patching was a small-caliber internal carotid artery (ICA) with a diameter less than 3.0 mm in 54 arteriotomies (60%). Patency of the endarterectomy was evaluated by completion arteriography in all instances. Follow-up was conducted after an intermediate postoperative period of 21 +/- 12.5 months in 69 sides by arteriography. A late follow-up was conducted at 55.4 +/- 11.2 months either by arteriography (in 45 sides) or by carotid duplex scanning (in 11 sides). Twenty-one patients with 23 endarterectomies died, only 1 of a cerebral event. Seven patients moved or refused study and five were lost to follow-up. Three recurrent stenoses and five carotid occlusions developed by the time of the intermediate follow-up. By the time of late follow-up, three additional patients developed recurrent stenoses. Our results suggest that recurrent stenosis continues to develop with a longer period of follow-up in patients undergoing venous patch angioplasty with carotid endarterectomy.
Headaches due to cerebrovascular disease. Subarachnoid hemorrhage causes sudden, severe headache and requires immediate medical and surgical diagnosis and treatment. A CT scan is the first choice for correct diagnosis. In order to prevent rebleeding, delays in treatment should be avoided. Intraparenchymal cerebral hemorrhage is now often recognized by means of CT scanning and sometimes is a cause of headache. Cerebellar hemorrhage commonly causes occipital headache and is an indication for immediate surgical intervention, although small cerebellar hemorrhages can be treated conservatively. Ischemic cerebrovascular disease is frequently accompanied by headache, but its etiology remains uncertain. Thrombosis of the cerebrovenous system is a less frequent cause of head pain than that of the arterial system, but it usually shows characteristic neurologic signs. Following carotid endarterectomy or superficial temporal artery-middle cerebral artery bypass surgery, the patient may have moderate to severe unilateral headaches, probably as a result of platelet aggregation and serotonin release.
Sodium and volume sensitivity of blood pressure. Age and pressure change over time. Salt sensitivity has been implicated in the age-related increase in blood pressure. We studied the reproducibility of a rapid method for assessing sodium sensitivity and resistance of blood pressure as well as the effect of age on this phenomenon. Blood pressure after volume expansion with 2 l intravenous saline (0.9%) over 4 hours was compared with that after 1 day of 10 mmol sodium chloride intake and 3 and 40 mg oral doses of furosemide. Normal and hypertensive subjects (n = 28) were studied twice within a year. Cross-sectional observations of the effect of age were made from studies in 230 hypertensive and 430 normotensive subjects. Longitudinal observations of blood pressure change over time were made 10 or more years after categorization of sodium responsivity in 31 subjects. The blood pressure response was reproducible in 28 subjects studied twice (r = 0.56, p less than 0.002). Four subjects changed salt-responsiveness status and six were indeterminate on restudy. Sodium sensitivity of blood pressure increased significantly with increasing age in the entire population (n = 660, r = -0.38, p less than 0.001). The relation was more striking in hypertensive subjects (n = 230, r = -0.31, p less than 0.001) in whom a progressive increase in salt sensitivity with decades was seen than in the normotensive group (n = 430, r = -0.19, p less than 0.01) in whom salt sensitivity was not observed until the sixth decade. Salt-sensitive subjects had a significantly greater increase in systolic (p less than 0.001) and diastolic (p less than 0.01) pressure over time than those who were salt-resistant. Salt sensitivity is a reproducible phenomenon that is related to the age-associated increase in blood pressure characteristic of industrialized societies. In addition, salt sensitivity can be shown to be a predictor of subsequent, age-related blood pressure increase.
Aztreonam in the treatment of gram-negative bacterial meningitis. Aztreonam was administered to 122 patients with presumptive or confirmed gram-negative bacillary meningitis in an open, multinational study. The antibiotic was administered at a dosage of 1-2 g to adults, 50 mg/kg to children greater than 2 years old, and 30 mg/kg to infants three or four times daily. Seventy-seven patients had microbiologically confirmed gram-negative meningitis due to an aztreonam-susceptible organism and received aztreonam for at least 48 hours. Haemophilus influenzae was the most frequently recovered pathogen (40 patients), followed by Enterobacteriaceae (16 patients), Neisseria meningitidis (15 patients), and Pseudomonas species (six patients). All but four patients were microbiologically cured. Microbiologic failure was associated with either a persistent intracerebral abscess (one patient) or a foreshortened course of therapy before microbiologic reevaluation and death (at 48 hours, 48 hours, and 72 hours after initiation of treatment, respectively). These data suggest that aztreonam is effective in the treatment of gram-negative bacillary meningitis caused by susceptible organisms.
The clinical significance and pathophysiology of stress-related gastric mucosal hemorrhage. Critically ill patients admitted to intensive care units (ICUs) develop a spectrum of gastroduodenal mucosal lesions that may result in mucosal hemorrhage and subsequent morbidity and mortality. Although stress-related mucosal lesions may be detected endoscopically in most critically ill patients, the incidence of clinically significant bleeding from these lesions is difficult to establish because of the heterogeneity in patient populations, the definitions of bleeding, and the methods of monitoring in various studies. Bleeding occurs overall in approximately 16% of patients not receiving prophylaxis, but the incidence of life-threatening hemorrhage appears to be much lower (less than 6%). In light of the increasing use of pharmacologic prophylaxis in ICUs, the clinical impact of stress-related bleeding and its prophylaxis is discussed in terms of bleeding incidence, morbidity and mortality, cost, and potential side effects. The pathophysiology of stress-related mucosal ulceration involves the complex interaction of gastric luminal factors, alterations in blood flow and intramucosal pH, and alterations in numerous factors that are normally responsible for maintaining an intact mucosa. The pathophysiology of stress ulceration is discussed, with an emphasis on cause-and-effect relationships, evolving areas of investigation, and implications for prophylaxis and treatment.
Cervical paraganglioma with subsequent intracranial and intraspinal metastases. Case report. Paragangliomas, tumors derived from the extra-adrenal paraganglion system, have commonly been found in the retroperitoneum, abdomen, mediastinum, skull base, and neck. Rare intraspinal cases have included involvement of the cauda equina and filum terminale, and a recent case has been reported of thoracic cord paraganglioma with metastasis to the cauda equina. The authors present the case of a patient with a cervical paraganglioma who underwent subtotal resection followed by postoperative irradiation; she subsequently developed multiple intracranial and intraspinal metastases 7 months following the first decompression procedure.
Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis. We studied 32 cases of Q fever endocarditis diagnosed in France between January 1985 and December 1989 to evaluate the efficacies of the different regimens of antibiotics used for treatment. Each patient was monitored during the treatment (range, 12 to 60 months), and clinical and biological information was computerized. Various treatments were prescribed, including doxycycline alone (9 cases) or in association with rifampin (4 cases), quinolones (16 cases), or sulfamethoxazole-trimethoprim (1 case). Two patients died before the beginning of the treatment. Nineteen patients had hemodynamic failure and subsequently underwent valve replacement. Nine valve tissue cultures were positive despite previous antibiotic treatment. In terms of their effects on mortality, the difference between doxycycline alone and doxycycline plus quinolones is statistically significant. We conclude that the addition of quinolones to doxycycline is beneficial. On the basis of clinical, serological, and valve tissue culture results, no treatment was able to cure Q fever endocarditis within 2 years, even with a combination of antibiotics. We advise a minimum duration of treatment of 3 years with therapy combining quinolones and doxycycline.
How prevalent is cancer family syndrome? Based on an established but pragmatic definition of cancer family syndrome as the presence of three or more relatives affected by colorectal cancer in a first degree kinship, the contribution of this syndrome to the total cancer burden in Northern Ireland has been studied by investigating all non-polyposis probands under 55 years old at histological diagnosis between 1976 and 1978. Family interviews were possible for 95% (n = 205) of all non-polyposis probands and verification of vital status or medical history was obtained for 98% of 1811 first degree relatives. The prevalence of cancer family syndrome was between 1 and 2%, a figure some fivefold less than that estimated elsewhere. A proximal tumour excess was not characteristic of the ascertained families. These results may have implications for the identification of susceptible people if screening for high risk groups is considered a worthwhile option for reducing colorectal cancer mortality in the United Kingdom.
Effects of dietary Ca2+ on erythrocyte Na(+)-transport systems in spontaneously hypertensive rats. 1. The purpose of this study was to determine the effect of dietary Ca2+ intake on blood pressure and erythrocyte Na+ transport in spontaneously hypertensive rats. 2. Spontaneously hypertensive rats and Wistar-Kyoto rats were fed diets with three different Ca2+ contents, 0.1% (low-Ca2+ diet), 0.6% (normal-Ca2+ diet) and 4.0% (high-Ca2+ diet), between 6 and 20 weeks of age. At 20 weeks of age, the levels of erythrocyte Na+ efflux, as well as Na+ and K+ contents in erythrocytes, were measured. 3. On the low-Ca2+ diet, spontaneously hypertensive rats showed an enhancement of hypertension. Conversely, on the high-Ca2+ diet, they showed an attenuation of the increase in blood pressure. Spontaneously hypertensive rats had a lower erythrocyte Na+ content and increased activity of the Na+ pump at higher levels of dietary Ca2+. Passive Na+ permeability and Na(+)-K+ co-transport were similar in spontaneously hypertensive rats on the low-, normal- and high-Ca2+ diets. There were no significant differences in blood pressure and in Na+ pump activity in WKY on the three different diets. 4. It is concluded that dietary Ca2+ might affect the regulation of blood pressure in spontaneously hypertensive rats by changing the activity of Na+ pump in the cell membrane.
Incidence and characteristics of preventable iatrogenic cardiac arrests We studied the contribution of iatrogenic illness to cardiac arrest among patients hospitalized in 1981 in a university teaching hospital. During this 1-year period, 28 (14%) of 203 arrests in which resuscitation was attempted followed an iatrogenic complication. Seventeen (61%) of the 28 patients died. The demographic characteristics of patients with iatrogenic arrest did not differ strikingly from those of other patients who arrested. However, patients with iatrogenic arrest were less likely to be in cardiogenic shock or to have suffered an acute myocardial infarction prior to arrest. They were more likely to survive to discharge from the hospital and to be taking digoxin or antiarrhythmic medication prior to arrest. Among the 28 cases of iatrogenic cardiac arrest, 18 (9% of all arrests) might have been prevented by stricter attention to the patient's history, findings on physical examination, and laboratory data. The most common causes of potentially preventable arrest were medication errors and toxic effects (44%) as well as suboptimal response by physicians to clinical signs and symptoms (28%), most frequently dyspnea and tachypnea. Rapid, appropriate response to abnormal drug levels, to electrocardiographic signs of adverse drug effects, and to signs and symptoms of congestive heart failure or toxic effects from digoxin might decrease the incidence of cardiac arrest among hospitalized patients.
Age-related normal values of signal-averaged electrocardiographic variables after acute myocardial infarction. The study examined standard time domain variables of a signal-averaged electrocardiogram (SAECG) in 328 survivors of acute myocardial infarction. The correlation of these variables with age and the influence of age on the prediction of postinfarction arrhythmic complication (sudden death [n = 12] or sustained ventricular tachycardia, or both [n = 14]) from the SAECG were investigated. Statistically highly significant correlations (p less than or equal to 0.00002) between age and SAECG variables were found. Compared with patients aged less than 60 years, the SAECG-based stratification of arrhythmic complications after myocardial infarction in patients greater than 60 years had lower sensitivity for the same values of specificity and lower specificity for the same values of sensitivity.
Factors influencing the outcome of congenital heart disease detected prenatally. The diagnosis of structural heart disease before birth is associated with a poor prognosis. Of 222 continuing pregnancies seen in a 10 year period, there has been a 79% mortality. This is inconsistent with published results and current concepts of the outcome for children with cardiac malformation. Of the 222, death occurred in intrauterine life in 57, 87 died as neonates, and 31 in infancy or childhood. There are 47 survivors of whom only five have survived beyond 4 years. Factors influencing the outcome in these cases were examined further. A high mortality was associated with the presence of extracardiac anomalies in 71 (32%) and prenatal cardiac failure in 28 (13%). As many patients were referred for these reasons, referral methods preferentially select patients with a different range of heart disease from that seen postnatally. In addition, some forms of heart disease progress in severity during fetal life. Those involved in the management and counselling after diagnosis of heart disease in early pregnancy must be aware of the additional prenatal factors influencing prognosis and allow for them in making predictions of outcome.
Proliferation of endocrine cells in the rat stomach caused by drug-induced achlorhydria. Time-related changes of serum gastrin levels, gastrin cell, and enterochromaffinlike cell densities, and proliferation kinetics of these cells have been examined in rats during treatment with the substituted benzimidazole BY 308 over a period of 73 days. Serum gastrin levels increased very rapidly from 74 +/- 6 pg/mL (controls) to 438 +/- 31 pg/mL (day 1) and 727 +/- 68 pg/mL (day 4). Thereafter, a steady increase was observed until day 70 (2097 +/- 208 pg/mL). Enterochromaffinlike cell density was unchanged until day 10, but then increased progressively without reaching a plateau (144% above control on day 73). The labeling index of these cells was enhanced shortly after drug application and remained on a constant elevated level from day 14 to day 73 (about 10-fold to 12-fold above controls from day 14 to day 70). The number of gastrin cells increased rapidly within the first week and reached a plateau after 17 days (96% increase above controls). In contrast to enterochromaffinlike cells, the labeling index did not change immediately but increased on day 7 by 37% and returned beneath control values after day 28. The results suggest that in drug-induced achlorhydria, the progressive increase of enterochromaffinlike cells is explained by an enhanced mitosis, whereas other factors in addition to proliferation are responsible for the augmentation of gastrin cells.
Independent risk factors for hepatocellular carcinoma in French drinkers. The aim of this study was to assess whether markers of hepatitis B virus or hepatitis C virus infection are independent risk factors for hepatocellular carcinoma in drinkers after adjustment for three known risk factors: cirrhosis, age and male sex. Among 2,015 consecutive drinkers admitted, hepatitis C virus antibodies were found by sensitive radioimmunoassay in 1,259. The following five factors have been identified and ranked as risk factors for hepatocellular carcinoma in unidimensional and regression analysis: cirrhosis (p less than 0.001), age (p less than 0.001), male sex (p less than 0.001), presence of HBsAg (p less than 0.001) and presence of hepatitis C virus antibodies (p less than 0.03). Among drinkers with cirrhosis, the patients with hepatocellular carcinoma were older (64 +/- 11 yr vs. 56 +/- 9 yr; p less than 0.001), were more often male (93% vs. 65%; p less than 0.0001) and had higher prevalence of HBsAg (9% vs. 2%; p = 0.02) and hepatitis C virus antibodies (41% vs. 26%; p = 0.02). A simple algorithm permitted us to identify a high-risk population of drinkers: the male cirrhotic patient older than 50 yr. The relative risk of hepatocellular carcinoma in this selected population was 17.7 (95% confidence interval = 9.0 to 37.5; p less than 0.0001). From a pragmatic point of view, the detection of HBsAg or hepatitis C virus antibodies, although independently associated with hepatocellular carcinoma, is not useful in increasing the diagnostic value of this algorithm because of the poor sensitivity of these tests. The weak relationships observed between hepatitis C virus antibodies and hepatocellular carcinoma needs confirmation by more accurate tests.
Antiphospholipid antibodies in cerebral ischemia. In a 2-year prospective study of 146 patients with cerebral ischemia, we compared vascular risk factors for stroke with clinical and laboratory findings, particularly antiphospholipid antibodies. Ten patients (6.8%) were positive for at least one antiphospholipid antibody; one patient had systemic lupus erythematosus, one had rheumatoid arthritis, and the remaining eight fulfilled criteria for the diagnosis of primary antiphospholipid syndrome. These patients were predominantly male, not necessarily young, and 50% of them did not have any other vascular risk factors; there were no significant clinical or paraclinical differences between these patients and those without antiphospholipid antibodies. Outcome in the 10 patients was good, and platelet antiaggregating drugs proved to be useful in preventing further cerebrovascular ischemic events in our patients.
Rectosigmoid varices and other mucosal changes in patients with portal hypertension. A prospective study was performed to evaluate the prevalence of anorectal varices and their clinical significance as well as to study other proctosigmoidoscopic changes in 75 patients with portal hypertension of diverse etiology. Sixty-seven patients (89.3%) had lower gastrointestinal varices with no significant difference (p greater than 0.05) in prevalence between cirrhosis (92.1%), noncirrhotic portal fibrosis (87%), and extrahepatic portal venous obstruction (85.7%). The rectum was the most common site of lower gastrointestinal varices. External anal and sigmoid colonic varices almost always occurred in the presence of rectal and/or internal anal varices. There was no correlation between the presence of rectosigmoid varices and the severity of esophagogastric mucosal changes or portal hypertension. There was no suggestion that esophageal variceal sclerotherapy influenced the presence of anorectal varices. Seven patients (9.3%) had recent hematochezia, including three patients in whom it occurred in the absence of any upper gastrointestinal hemorrhage. Varices were the cause of bleeding in at least five patients. An abnormal mucosal vascular pattern in the form of telangiectasias or spiders was seen, irrespective of etiology of portal hypertension, in nine patients (12%). Hemorrhoids were present in 31 patients (41.3%) with an age-related difference (p less than 0.05) between patients with cirrhosis (55.3%) and extrahepatic portal venous obstruction (21.4%).
Revascularization of infarcted myocardium. Effect on myocardial perfusion assessed with quantified Tl-201 SPECT technique. Myocardial perfusion was studied in 21 patients before and after revascularization of all graftable stenotic vessels following post-infarction anteroapical akinesia and minor dyskinesia. At preoperative and late postoperative evaluation, perfusion abnormalities in identified sectors were quantified with two methods, one (Q1) assessing the extent and the other (Q3) the severity of abnormal perfusion. The preoperative scores with both methods indicated permanent myocardial perfusion defects in all 21 patients and reversible defects, indicating myocardial ischemia, in 16 with Q1 and 14 with Q3. After bypass grafting there was overall reduction of myocardial perfusion defect and of abnormality scores: Notably, 13/21 patients (62%) had decreased permanent myocardial defect score, reflecting reactivation of 'hibernating myocardium'. The findings indicated that obstructed but graftable vessels supplying myocardium with loss of contractile function should be bypassed, since flow contribution to distant, viable myocardium is probable via preserved collateral circulation. This should be particularly relevant for the LAD, because of that artery's septal branches.
Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. The impact of nonrheumatic atrial fibrillation, hypertension, coronary heart disease, and cardiac failure on stroke incidence was examined in 5,070 participants in the Framingham Study after 34 years of follow-up. Compared with subjects free of these conditions, the age-adjusted incidence of stroke was more than doubled in the presence of coronary heart disease (p less than 0.001) and more than trebled in the presence of hypertension (p less than 0.001). There was a more than fourfold excess of stroke in subjects with cardiac failure (p less than 0.001) and a near fivefold excess when atrial fibrillation was present (p less than 0.001). In persons with coronary heart disease or cardiac failure, atrial fibrillation doubled the stroke risk in men and trebled the risk in women. With increasing age the effects of hypertension, coronary heart disease, and cardiac failure on the risk of stroke became progressively weaker (p less than 0.05). Advancing age, however, did not reduce the significant impact of atrial fibrillation. For persons aged 80-89 years, atrial fibrillation was the sole cardiovascular condition to exert an independent effect on stroke incidence (p less than 0.001). The attributable risk of stroke for all cardiovascular contributors decreased with age except for atrial fibrillation, for which the attributable risk increased significantly (p less than 0.01), rising from 1.5% for those aged 50-59 years to 23.5% for those aged 80-89 years. While these findings highlight the impact of each cardiovascular condition on the risk of stroke, the data suggest that the elderly are particularly vulnerable to stroke when atrial fibrillation is present.
Rubella susceptibility of an infertile population. The recent trend reported by the CDC reaffirms that rubella continues to be a health care issue and should be a concern particularly for those who care for women in the childbearing age group. Immunization of all susceptible women will not only offer them protection but reduce the pool of susceptible individuals that can transmit the disease.