shukoor65/lab-rag-model huggingface dataset:
Efficient diagnosis of common complaints: a comparative study in the United States and England. BACKGROUND. The purpose of this investigation was to compare the diagnostic efficiency of American and British family and general practitioners, as measured by their utilization of health care resources and the average length of the diagnostic interval, in diagnosing common complaints. METHODS. Several hundred charts from teaching practices in the United States and England were identified by computer search and reviewed. The charts were those of patients who had presented between 1978 and 1988 with a complaint of chest pain and were subsequently diagnosed as having angina pectoris or reflux esophagitis, or who presented with a complaint of shortness of breath and were subsequently diagnosed as having heart failure or asthma. RESULTS. The results of this study, which compared teaching family medicine practices in the United States and England, suggest that American family physicians diagnose common complaints such as chest pain and dyspnea in a shorter time with fewer visits and fewer consultations than their English counterparts, but order approximately the same number of diagnostic tests. CONCLUSIONS. This study demonstrates the difficulties in interpreting international (cross-cultural) comparisons. Differences may be due to varying health care systems, economic factors, physician training, and physician practice styles, as well as patient expectations.
Complications associated with brachytherapy alone or with laser in lung cancer. Relatively little has been reported about destruction through brachytherapy of mucosa-perforating and extraluminary tumors with probable large vessel involvement causing major hemorrhagic or fistular complications. We report 12 patients subjected to laser and brachytherapy for centrally occluding lung cancer, whom we have periodically followed up from June 1986 until they died. Although all laser procedures were free from complications, necrotic cavitation in five cases, two of which were accompanied by large bronchoesophageal fistulas, and massive fatal hemoptysis occurred in six. Minor complications included radiation mucositis (two), noncritical mucosal scarring (two), and cough (four). Characteristics that will identify patients at risk of developing fatal hemoptysis and fistulas should be better defined by imaging and endoscopic techniques. In such cases, modifying the protocol or using alternative procedures should be considered. Minor complications, such as cough, can be avoided by using topical steroid therapy (eg, beclomethasone dipropionate).
Genetic control of immunopathology induced by Mycobacterium leprae. The pathogenesis of leprosy is almost totally attributable to the immune response of the host towards Mycobacterium leprae, a virtually non-toxic intra-cellular parasite. At one end of the leprosy spectrum are tuberculoid leprosy patients, who develop immunity but also delayed-type hypersensitivity towards M. leprae; at the other end are lepromatous leprosy patients, who lack helper T cell activity and therefore do not develop immunity, but who can nevertheless produce antibodies that may cause immunopathology due to immune complexes. A range of immunopathology is seen between these poles.
Sensorineural hearing loss and the Marinesco-Sjogren syndrome. Sensorineural hearing loss has not been previously reported in patients with the Marinesco-Sjogren Syndrome. Two siblings are described where hearing was initially normal but subsequently deteriorated.
Coughing and central venous catheter dislodgement. Silastic central venous catheters are subject to dislodgement from a variety of causes. Only one occurrence of catheter dislodgement has been previously reported in connection with coughing. We report four additional cases of silastic central venous catheter dislodgement associated with forceful coughing paroxysms, alone or in combination with emesis or rectal tenesmus. Three episodes of catheter dislodgement occurred in adolescents or young adults with cystic fibrosis, who may constitute a particularly high-risk group. Dislodgement in two patients was asymptomatic. These case suggest that patients with frequent or severe paroxysms of increased intrathoracic pressure may be at higher risk of catheter dislodgement. Since dislodgement may be initially asymptomatic and can cause serious complications, a high index of suspicion for dislodgement in patients with silastic central venous catheters and coughing paroxysms is advised.
DuP 753 increases survival in spontaneously hypertensive stroke-prone rats fed a high sodium diet. We studied the effects of the nonpeptide angiotensin II receptor antagonist, DuP 753, on blood pressure, body weight, plasma renin activity, sodium excretion, and mortality in male stroke-prone spontaneously hypertensive rats (SHRsp) fed a 4% NaCl diet for 12 weeks. The rise in blood pressure, due to high sodium intake, was blunted in the first 8 weeks of the study in the DuP 753-treated group; however, it started slowly to rise in the following weeks. In the untreated group, blood pressure rose steadily and it was significantly higher than that of the treated group during the whole experimental period. DuP 753-treated rats gained weight continuously during the study in contrast to the untreated group, where weight gain was arrested after 4 weeks. Plasma renin activity rose significantly after 4 weeks of treatment with DuP 753; by week 6 its values returned to baseline values and remained at these lower values until week 12. In the untreated group, plasma renin activity was not suppressed by high sodium intake after 4 weeks; it continued to rise and it was significantly elevated by 8 and 12 weeks. Survival at 12 weeks was 84% in DuP 753-treated group and 26% in the untreated group. The data demonstrate that DuP 753 decreased mortality and dramatically blunted the blood pressure rise in SHRsp fed a high sodium diet.
Endometriosis of the terminal ileum simulating the clinical, roentgenographic, and surgical findings in Crohn's disease. A 38-yr-old nulliparous female presented with endometriosis of the terminal ileum which mimicked the clinical, roentgenographic, and surgical findings of Crohn's disease. The patient presented with diarrhea, right lower quadrant pain, fever, and significant weight loss. At surgery, the terminal ileum was inflamed, indurated, thickened, and angulated. Ileal endometriosis may be expected to simulate Crohn's disease, because intestinal endometriosis frequently produces local bowel inflammation, adhesions, stricture, and angulation. Ileal endometriosis should be carefully considered in the differential diagnosis of Crohn's disease in menstruating females who are nulliparous and have dysmenorrhea, dyspareunia, dyschezia, menometrorrhagia, or other perimenstrual symptoms. It is important not to mistake endometriosis for Crohn's disease because endometriosis has a different therapy.
Clinical and flow cytometry characteristics of malignant pleural effusions in patients after intracavitary administration of methylprednisolone acetate. Ten patients with recurrent pleural effusions due to advanced cancer were treated by intracavitary methylprednisolone acetate (Depo-Medrol [DM], Upjohn, Kalamazoo, MI). They received one to six courses of DM (median, three courses per patient) with doses ranging from 80 to 160 mg per course. Effusion cells were cryopreserved before and during DM installation for subsequent determination of ploidy by flow cytometry. Pleural effusion in all three patients with advanced breast cancer resolved and did not reaccumulate throughout follow-up for 11+, 10+, and 8+ months. Pleural effusion in a patient with metastatic gastric cancer and in two of four patients with adenocarcinoma of unknown origin partially resolved. Altogether six of ten patients (60%) subjectively and objectively benefited from this therapy. All patients tolerated the treatment well with no local or systemic side effects. Flow cytometry showed a reduction in ploidy of effusion cells in all three patients with breast cancer, from a peak mean channel of 6C to nearly 2C after therapy. Transient reduction of ploidy was seen also in the effusion of a patient with unknown primary tumor associated with clinical improvement. The clinical and laboratory data reported offers initial evidence that DM when instilled into the pleural cavity after incomplete thoracentesis may act as effective palliative therapy either alone or in combination with other anticancer agents.
Total hip arthroplasty following failed internal fixation of hip fractures. A retrospective review was performed on 27 consecutive patients with total hip arthroplasty (THA) following failure of internal fixation of fractures of the proximal femur. The results were comparable to primary THA in femoral neck fractures. Considerably less satisfactory results were obtained in THA in intertrochanteric fractures. Bone loss and medial displacement of the femoral shaft led to high incidence of intraoperative complications and postoperative dislocations. Extreme care must be taken to avoid fracture and penetration of the femoral shaft. Autograft, allograft, or head and neck replacement components should be available for reconstruction of the difficult cases.
A randomized trial of amsacrine and rubidazone in 39 patients with acute promyelocytic leukemia. Thirty-nine patients with untreated acute promyelocytic leukemia (APL) were randomly allocated to receive rubidazone (zorubicin) 200 mg/m2/d, days 1 to 4 plus cytarabine (Ara C) 200 mg/m2/d, days 1 to 7 (arm A, 21 patients), or amsacrine (Amsa) 150 mg/m2/d, days 1 to 4 plus Ara C 200 mg/m2/d, days 1 to 7 (arm B, 18 patients). Prophylaxis of disseminated intravascular coagulation was made by platelet transfusions and heparin. In case of leukemic resistance, patients received a second course with 2 days of rubidazone (arm A) or Amsa (arm B) and 3 days of Ara C. Patients who achieved complete remission (CR) received three consolidation courses with the two drugs used for induction and maintenance therapy for 3 years. Two patients in arm A and one in arm B were allografted in first CR. Initial characteristics were similar in both arms. In arm A, 18 patients (86%) reached CR, two had hypoplastic death, and one had leukemic resistance after two courses. In arm B, 12 patients (66%) achieved CR, two had early death (CNS bleeding, one case; ventricular fibrillation, one case), and four had resistant leukemia after two courses. The difference in CR rate between the two arms was not significant. In arm A, disease-free survival (DFS) showed a plateau at 54.3% after 34 months (95% confidence interval [CI], 32.1% to 74.9%), with eight CRs longer than 34 months. In arm B, DFS was significantly shorter (P less than .03), showing a plateau at 16.7% after 38 months (95% confidence interval, 4.7% to 44.6%), and only two prolonged CRs were seen. The difference in DFS remained significant after censoring allografted patients and patients who died in CR (one in arm A, two in arm B). Our results suggest that Amsa-Ara C combinations may be inferior to anthracycline-Ara C combinations in the treatment of APL, because they seem to provide shorter DFS and, possibly, a higher incidence of initial leukemic resistance. However, studies with larger numbers of patients are required.
Clinical findings associated with pulmonary embolism in a rehabilitation setting. In a rehabilitation setting, pulmonary embolism is a relatively frequent and life-threatening complication. Deciding when a patient may be experiencing this condition is difficult, however, because of frequent deficits in patient communication skills (eg, aphasia and cognitive deficits) and the multisystem illnesses affecting many rehabilitation patients. We reviewed the charts of 30 rehabilitation patients transferred emergently during the years 1986 to 1988 with a diagnosis of pulmonary embolism, which was subsequently documented by ventilation-perfusion scanning. The average age of the 30 patients was 65; 63% were women and 20 (67%) had an admitting diagnosis of stroke. The most common new-onset clinical findings in the 24 hours before discharge were unusual facial skin color changes (pale, flushed, or cyanotic) (57%), chest or upper back pain (47%), tachycardia (heart rate more than 100 bpm) (40%), hypoxemia (arterial oxygen saturation less than or equal to 90%) (40%), and fever less than 101F (37%). In 63% of the patients, either anxiety, restlessness, diaphoresis, or dyspnea was also noted in the 24 hours before discharge. The data suggest that careful physician and nursing scrutiny may identify clinical signs characteristic of pulmonary embolism, and that the de novo appearance of these constellations of findings may help to select candidates for ventilation-perfusion scanning.
Long-term survival in patients operated on for benign peptic ulcer disease. Survival rate was analysed in a cohort of 6459 patients who had undergone partial gastrectomy for benign ulcer disease and who had survived the first year after operation. The cohort was followed for 27-35 years. There was a slight but significant decrease in relative survival rate to 92 per cent (95 per cent confidence interval 87-97 per cent) 35 years after operation. No decrease in relative survival rate was observed during the first 20 years after operation. There was no difference by gender or surgical procedure, but patients operated on for gastric ulcer, compared with duodenal ulcer, and patients operated on at younger ages had a poorer relative survival rate. The effects of partial gastrectomy on survival, both overall and by diagnosis or age at operation, are probably attributable to confounding factors linked with the peptic ulcer disease rather than to the surgical procedure itself. We conclude that partial gastrectomy seems to have very little impact on survival once the patient has survived the first year after operation.
Pituitary adenoma: correlation of half-dose gadolinium-enhanced MR imaging with surgical findings in 26 patients. Sellar magnetic resonance imaging studies obtained with half doses of gadopentetate dimeglumine (0.05 mmol/kg) were prospectively interpreted and retrospectively rated in 26 patients who subsequently underwent transsphenoidal sellar surgery for suspected pituitary adenoma. Studies included a sagittal scout view followed by a non-contrast-material-enhanced, an immediate postcontrast, and a delayed postcontrast T1-weighted image (obtained at 1.0 or 1.5 T). Ten of 11 confirmed microadenomas were identified prospectively; all were identifiable in retrospect. Macroadenomas (12 cases) were well demonstrated. The high signal intensity of the posterior pituitary and of intrasellar hemorrhage was obscured on postcontrast studies. Delayed images proved unnecessary. This prospective evaluation suggests that a half-dose study is comparable to retrospective studies in which full-dose techniques were used for detection of micro- and macroadenomas. Imaging times are reasonably short, and cost of contrast material is potentially reduced. Confirmation with larger studies is required, and careful endocrinologic and clinical follow-up of nonsurgical patients is necessary.
Metastatic basal cell carcinoma: report of a case presenting with respiratory failure. Metastasis from basal cell carcinoma (BCC) of skin is rare. A case of a 58-year-old male presenting with increasing shortness of breath and right pleural effusion is described. Open right pleural biopsy demonstrated metastatic carcinoma consistent with BCC. Review of medical records from another hospital revealed that four years previously a recurrent BCC had been excised from the left back. One and three years prior to this excision, a skin lesion at this same site had been treated with electrocautery. Review of the skin excision slides demonstrated infiltrating BCC histologically very similar to the metastatic pleural neoplasm. The patient died two months after the pleural biopsy. At autopsy, the cutaneous BCC had not recurred and metastatic BCC extensively infiltrated the pleura bilaterally, with focal involvement of underlying lung parenchyma, subcarinal lymph nodes, diaphragm, and pericardium.
A new manifestation and treatment alternative for heparin-induced thrombosis. We treated a coronary artery bypass patient whose postoperative course was complicated by heparin-induced thrombocytopenia and resultant pulmonary artery and saphenous vein graft thromboses. The pulmonary thromboemboli were found first, and pulmonary blood flow was restored with intravenously administered tissue plasminogen activator (tPA). A short time later, the vein grafts were found to be occluded, and we subsequently performed multivessel percutaneous transluminal coronary angioplasty (PTCA) using tPA as an adjuvant to oral warfarin sodium therapy with excellent results. We conclude that heparin-induced thromboses in the pulmonary arteries are amenable to thrombolytic therapy, including tPA, whereas this regimen appears to have little effect on saphenous vein grafts. We also found that a combination of warfarin and thrombolytic therapy is an alternative regimen for heparin-intolerant patients who require PTCA.
Seminal polyamines as agents of cervical carcinoma: production of aneuploidy in squamous epithelium. The effects of several polyamines found in seminal fluid on the cell cycle and ploidy of three cervical cell lines and of primary epithelial cells cultured from cervical biopsy specimens were monitored by fluorescent flow cytometry. The rate of cell growth did not change but there were indications of either hypodiploidy or hyperdiploidy in some cultures at certain concentrations of spermine and spermidine. An interaction of exogenous polyamines with the DNA of cervical cells was shown to occur, leading to changes in ploidy with, perhaps, the potential to induce or promote dysplasia.
Longitudinal study of cerebral spinal fluid drainage in polyethylene glycol-conjugated superoxide dismutase in paraplegia associated with thoracic aortic cross-clamping. It has been hoped that pharmacologic prophylaxis in thoracic aortic cross-clamping may avert the unpredictable complication of spinal cord paraplegia, may avoid the mechanical difficulties associated with shunts, partial bypass, or monitoring devices, and may serve as a substitute for or as an adjunct to cerebral spinal fluid drainage. Toward this end 21 mongrel dogs were studied in four groups and underwent 60 minutes of thoracic aortic cross-clamping: group I, five with thoracic aortic cross-clamping; group II, five with thoracic aortic cross-clamping and cerebral spinal fluid drainage; group III, five with thoracic aortic cross-clamping, cerebrospinal fluid drainage and intravenous administration of a single dose (5000 units/kg) of polyethylene glycol-conjugated superoxide dismutase (PEG-SOD) given 15 to 20 minutes before thoracic aortic cross-clamping; and group IV, six with thoracic aortic cross-clamping and PEG-SOD. Paraplegia was graded by the Tarlov method at 24 hours and up to 5 days after thoracic aortic cross-clamping. The carotid and femoral artery pressures, the central venous pressure, and core temperature, taken during the experiment and at the time the dogs were killed, were found to be similar between groups. At 24 hours all dogs in group I were paraplegic; groups II and III had no paraplegic dogs (p less than 0.01), and group IV had fewer paraplegic dogs (two of six) than group I (p less than 0.05). Paraplegia was averted in all dogs treated with cerebral spinal fluid drainage, even 5 days after thoracic aortic cross-clamping.
Gadopentetate dimeglumine-enhanced chemical-shift MR imaging of the breast. Standard T1-weighted MR images enhanced with gadopentetate dimeglumine show relatively minimal enhancement of breast lesions due to the high background signal from fat in the breast. Strongly enhancing lesions may become isointense relative to the fat signal and become invisible or indistinct after contrast administration. Fat-suppressed chemical-shift imaging (CSI) combined with administration of gadopentetate dimeglumine improves lesion detection and characterization in other areas of the body where a strong lipid signal is present. We evaluated this technique in the breast. Twenty patients with mammographic lesions were studied with standard unenhanced T1- and T2-weighted images and enhanced T1-weighted images, as well as with CSI before and after administration of gadopentetate dimeglumine. The series were ranked independently for border and matrix characteristics. The border was assessed for a smooth, irregular, or spiculated margin. The matrix or internal substance was evaluated for visibility and type of enhancement, homogeneous or inhomogeneous. The enhanced CSI images were superior to all other images in the depiction of border and matrix characteristics. Of 20 patients, a corresponding mass was detected on MR in 14. In two of the 14 patients, the lesion was seen only in the enhanced CSI images. Chemical-shift artifacts on enhanced T1-weighted images obscured border detail in several cases. Enhanced CSI improves visualization of breast lesions as compared with conventional MR imaging with or without enhancement. The enhanced CSI technique produces differential enhancement between glandular tissue and lesions while suppressing the signal from fat. This improves the visualization of border and matrix characteristics and depicts lesions that otherwise might be obscured.
Safety-belt injuries in children with lap-belt ecchymosis: CT findings in 61 patients. We have noted a complex of common injuries in children wearing lap-styled safety belts during vehicular accidents. Sixty-one children who were restrained passengers in motor vehicle crashes had linear ecchymosis across the abdomen and had CT for abdominal trauma. Thirteen children (21%) had a lumbar spine injury, and 14 children (23%) injured a hollow viscus (bowel, 12; bladder, two); five children (8%) had both spine and hollow viscus injuries. Abnormal findings on abdominal CT were recognized retrospectively in three of 13 children with lumbar spinal injury. Lateral radiographs of the spine showed lumbar spinal injury in all cases. Free intraperitoneal air was noted in on three (25%) of 12 children with bowel injury. In eight of those children, CT showed large, unexplained collections of peritoneal fluid. The presence of lap-belt ecchymosis should prompt a careful search for spine, bowel, and bladder injury. Recognition of the limitations of CT diagnosis of these injuries is important to reduce errors in interpretation.
Achromobacter xylosoxidans. An unusual neonatal pathogen. Perinatal acquisition of a rare pediatric pathogen, Achromobacter xylosoxidans, with evidence for in utero transmission, is described. Cultures from the mother and neonate demonstrated A. xylosoxidans. An ascending bacterial infection in the mother with clinical chorioamnionitis is presented as the probable mode of transmission. Postmortem examination of the infant confirmed Achromobacter meningitis. In contrast to the current case with transmission from mother to neonate, previously published neonatal cases of Achromobacter infections indicate that nosocomial transmission of the organism is most common (79%). In addition, the literature review revealed a high mortality associated with meningitis (77%), frequent hydrocephalus, and subsequent neurologic sequelae (36%). To the authors' knowledge, this is the first documented case of maternal-fetal transfer of A. xylosoxidans.