shukoor65/lab-rag-model huggingface dataset:
Application of hepatitis B virus (HBV) DNA sequence polymorphisms to the study of HBV transmission. Short sequences in hypervariable regions of the hepatitis B virus (HBV) genome can be used to identify different strains, providing a novel approach to the study of HBV transmission. The nucleotide sequence in positions 2551-2650 (1:EcoRI site) was determined for serum HBV DNA from 96 Chinese children living in Hong Kong and from 38 of their parents. HBV DNA was extracted and sequenced after amplification with the polymerase chain reaction, using as primers oligonucleotides corresponding to two conserved sequences. Among 82 unrelated children, 32 HBV DNA variants were present. One sequence was present in 33 children and 31 variants were found among the other 49. Siblings within each of nine families had the same variant; in three families siblings had different variants. Six of the eight fathers and 28 of the 30 mothers had HBV DNA sequences identical to those of their offspring. A total of 34 variants were found among the 134 individuals. The hypothesis of random assortment of sequences in parents and children was rejected (P less than .00005). Thus, this new approach proves the occurrence of intrafamilial transmission of HBV among Chinese.
Antiemetic efficacy of ondansetron after outpatient laparoscopy. The safety and efficacy of ondansetron were evaluated for the treatment of postoperative nausea and vomiting after laparoscopic surgical procedures. Seventy-one healthy, consenting outpatients were randomly assigned to one of two treatment groups according to a double-blind, placebo-controlled protocol. A standardized anesthetic technique consisting of alfentanil-thiopental-succinylcholine for induction and alfentanil-nitrous oxide-succinylcholine for maintenance of anesthesia was used. Patients in whom postoperative nausea and/or vomiting developed and persisted for greater than or equal to 10 min received equivolemic intravenous injections of either ondansetron (8 mg) or saline (placebo) over a 2-5 min period. Ondansetron significantly decreased the posttreatment nausea scores (vs placebo) without increasing sedation or producing changes in cardiorespiratory parameters. In the placebo-treated group, 92% of the patients experienced subsequent episodes of vomiting in the postanesthesia care unit compared with 51% of the patients in the ondansetron group. Finally, only 43% of the ondansetron-treated patients required a "rescue" antiemetic compared with 86% in the placebo group. Thus, ondansetron (8 mg IV) was associated with a decreased incidence of nausea and vomiting after outpatient laparoscopic procedures.
Racial differences in responses to thrombolytic therapy with recombinant tissue-type plasminogen activator. Increased fibrin(ogen)olysis in blacks. The Thrombolysis and Angioplasty in Myocardial Infarction Study Group. To determine whether there are differences in responses to thrombolytic therapy in certain populations, the data for the Thrombolysis and Angioplasty in Myocardial Infarction (phase 1) study were analyzed for black and white patients. Baseline variables including risk factors and extent of coronary artery disease were similar in the 352 white and 24 black patients. The time from onset of chest pain to recombinant tissue-type plasminogen activator (rt-PA) therapy and rt-PA dosing regimens were the same in the two groups. The patency rate of the infarct-related artery at 90 minutes was 91% for blacks and was 72% for whites (p = 0.051). Blacks displayed significantly lower nadir fibrinogen levels (0.57 +/- 0.62 versus 1.3 +/- 0.76 g/l, p less than 0.0001), greater delta fibrinogen (baseline-nadir) (2.7 +/- 1.1 versus 1.7 +/- 1.1 g/l, p less than 0.0001), and increased peak levels of fibrin(ogen) degradation products (837 +/- 865 versus 245 +/- 475 micrograms/ml, p less than 0.0001). rt-PA antigen levels tended to be higher in blacks than in whites (2.8 +/- 2.2 versus 2.2 +/- 3.2 micrograms/ml [p = 0.10] at the peak and 1.6 +/- 1.3 versus 0.99 +/- 1.4 micrograms/ml [p = 0.06] at the end of the maintenance infusion). Major clinical outcomes including survival until time of hospital discharge (92% black versus 93% white, p = 0.68) were not significantly different. However, despite undergoing fewer angioplasty procedures (25% versus 46.3%, p = 0.047), blacks received more transfusions (58.8% versus 19.5% were administered greater than or equal to 2 units packed erythrocytes, p = 0.001).
Cutaneous silica granuloma. A rare entity or rarely diagnosed? Report of two cases with review of the literature. Cutaneous silica granuloma is a poorly understood, uncommon condition that may mimic cutaneous sarcoidosis. We describe two cases of this entity and their characteristic latency period (between the time of silica exposure to the time of clinical onset of granuloma). We also review the histologic and energy dispersive x-ray analysis data, which prove the diagnosis. This condition should be recognized as an occupational dermatosis as well as the result of past incidental cuts or abrasions, which result in the development of granulomas, many in old wound scars. Differentiation from cutaneous sarcoidosis is possible with polarized light microscopy and energy-dispersive x-ray analysis.
Congenital keratinizing desquamative squamous epithelium of the entire urinary tract. We report the clinical and pathological findings of a case of congenital desquamative squamous epithelium of the entire urinary tract associated with body dysmorphism. This entity has not been described previously in the literature.
Comparison of needle aspiration cytologic diagnosis with excisional biopsy tissue diagnosis of palpable tumors of the breast in a community hospital. Fine needle aspiration cytologic examination has not extensively been used in our hospital in the work-up evaluation of solid tumors of the breast and its reliability as a basis on which to perform definitive treatment of carcinoma of the breast was in question. One hundred and five aspiration cytologic specimens were obtained from palpable solid tumors of the breast just prior to excisional biopsy. Specimens were numbered and submitted to three different staff pathologists for diagnosis in a single blind manner. Results were then compared with tissue diagnosis of the same tumors. Of 105 specimens taken at biopsy of the breast, 28 malignant lesions were diagnosed on the final tissue report. Of those, ten were diagnosed as malignant (Class V), two were highly suspicious (Class IV) and six were insufficient specimens (Class O). Of those diagnosed as class IV and V by the results of cytologic examination, all were malignant on permanent section for a specificity of 100 per cent and a sensitivity of 36 per cent. The cytologic diagnoses of Classes I, II and III did not correlate with any histologic report, benign or malignant. Malignant growths were misdiagnosed by cytologic examination in 36 per cent and missed because of inadequate specimens in 28 per cent. We believe that a Class V cytologic finding is sufficient basis on which to perform definitive treatment of carcinoma of the breast provided rigid criteria are used. There is a learning curve associated with this diagnostic modality.
Diabetes-induced alterations in atrial natriuretic peptide gene expression in Wistar-Kyoto and spontaneously hypertensive rats. We investigated the effects of streptozotocin-induced diabetes on atrial natriuretic peptide (ANP) synthesis, hemodynamic parameters, blood volume, and histopathology, as well as the reversibility of such effects with insulin therapy in Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHRs). The biatrial ANP messenger RNA (mRNA) levels in the diabetic WKY rats increased by 16-17% compared with those in the age-matched WKY rats at 12 weeks after the onset of diabetes, whereas their ventricular ANP mRNA levels showed increases of 190% in left ventricles and 160% in right ventricles at 8 weeks. In the diabetic SHRs, the left atrial ANP mRNA levels increased by 36% compared with those in the age-matched SHRs, as early as 4 weeks after diabetes onset. Their ventricular ANP mRNA levels also showed 80-82% increases in left and right ventricles at 4 weeks. In proportion to changes in cardiac ANP synthesis, the biventricular end-diastolic pressures were significantly elevated at 8 weeks in the diabetic WKY rats and at 4 weeks in the diabetic SHRs. The blood volume significantly increased at 8 weeks in the diabetic WKY rats and remained higher thereafter, whereas it did not change in the diabetic SHRs throughout the experimental period. The left ventricular peak dP/dt was depressed in the 8-week diabetic SHRs, whereas in the diabetic WKY rats, its depression was observed at 12 weeks after diabetes onset. Histopathological studies showed that diabetic changes in ANP synthesis and hemodynamic parameters described above occurred before the cardiomyopathic histological changes. Cardiac ANP synthesis in the diabetic rats completely reverted to control levels after insulin therapy, accompanied by normalization of hemodynamic parameters. The present study indicates that 1) ANP synthesis is significantly augmented in the streptozotocin-induced diabetic rat compared with that in the normal rat, and the combination of diabetes and hypertension produces an earlier and greater effect in stimulating cardiac ANP synthesis than does either disease alone; 2) an elevation in the intraventricular filling pressure that occurs before observable cardiomyopathic histopathological alterations might be involved partially in the augmented ANP synthesis; and 3) the reversibility with insulin therapy suggests that the streptozotocin-induced alterations observed in cardiac ANP synthesis and hemodynamics result from insulin-deficient diabetes mellitus, not from cardiac toxicity of streptozotocin.
Lack of effect of peroral acyclovir for the treatment of acute infectious mononucleosis. Perorally administered acyclovir was evaluated in the therapy of acute infectious mononucleosis in a multicentered, randomized, double-blind, placebo-controlled trial. A total of 120 patients received 600 mg of acyclovir or placebo five times daily for 10 days. All patients were entered into the study within 7 days of symptom onset and had a positive Monospot test. Analysis of mean values and time to resolution of fever, lymphadenopathy, weight change, hepatomegaly, splenomegaly, liver function tests, atypical lymphocytes, hours of bed rest, sense of well-being, and return to normal activities revealed no significant differences. There was a trend toward suppression of Epstein-Barr virus excretion in the oropharynx in acyclovir recipients. No toxicity was detected in patients treated with acyclovir. Under the conditions of the study, there was no evidence that treatment with perorally administered acyclovir affected the course of infectious mononucleosis.
Eicosapentanoic acid suppresses intimal hyperplasia after expanded polytetrafluoroethylene grafting in rabbits fed a high cholesterol diet. The effect of purified eicosapentanoic acid on intimal fibrous hyperplasia in expanded polytetrafluoroethylene grafts was examined in 18 rabbits undergoing infrarenal aorta reconstruction. Six rabbits received commercial rabbit chow (control group), six a regular diet supplemented with 1% cholesterol (cholesterol group), and six the cholesterol diet with 91.1% pure eicosapentanoic acid 500 mg/day (eicosapentanoic acid group). Grafts were harvested 3 months after surgery for histologic examination. The platelet count and serum beta-thromboglobulin and platelet factor 4 concentrations were not significantly different between groups. Serum arachidonic acid level in the cholesterol group was significantly higher than in the control group, and serum eicosapentanoic acid levels in the eicosapentanoic acid group were significantly higher than in the remaining two groups. Intergroup differences in serum 6-keto-prostaglandin F1 alpha and thromboxane B2 concentrations were not significant. Intimal thickness at midgraft was 5.2 +/- 6.2 microns in the control group, 67.6 +/- 46.9 microns in the cholesterol group, and 19.2 +/- 18.4 microns in the eicosapntanoic acid group. intimal thickness in the cholesterol group was greater than in either the control or licosapentanoic acid group (p less than 0.01 and p less than 0.05, respectively). These data suggest that eicosapentanoic acid reduces intimal fibrous proliferation in expanded polytetrafluoroethylene grafting as a result of hypercholesterolemia and that this effect is independent of the platelet count, activated platelet factors, and the prostacyclin/thromboxane A2 ratio.
Transforming growth factor alpha expression helps to distinguish keratoacanthomas from squamous cell carcinomas. Keratoacanthomas may be difficult to distinguish histologically from squamous cell carcinomas. We studied 20 keratocanthomas and 22 squamous cell carcinomas immunohistochemically using an antibody directed against transforming growth factor alpha to determine if the pattern of transforming growth factor alpha expression would provide a useful method of differentiating these tumors. Ninety percent of the keratoacanthomas demonstrated a diffuse pattern within tumor lobules in which all but the most peripheral rim of cells were stained. A similar localization of transforming growth factor alpha was not identified in squamous cell carcinomas. In addition, 40% of the squamous cell carcinomas but none of the keratoacanthomas showed focal transforming growth factor alpha immunostaining. Our results suggest that transforming growth factor alpha expression may be a marker of epithelial differentiation and may help distinguish between these two tumors.
Newer variants and simulants of basal cell carcinoma. Basal cell carcinoma (BCC) has characteristic clinical and histopathologic findings that facilitate accurate diagnosis. There are, however, many variants and simulants of BCC that may cause clinical and/or histopathologic confusion. These entities often have features in common with BCC, with nodular or sclerosing basaloid islands, peripheral palisading, stromal retraction, (pseudo)-glandular formation, and/or prominent mucin. Recently described BCC variants, including signet-ring BCC and granular cell BCC, are discussed. Less commonly appreciated basaloid simulants, including ameloblastoma, cloacogenic carcinoma, and mucinous carcinoma, are described. Distinguishing among these variants and simulants of BCC is important because treatment and prognosis of each may vary.
Serum testosterone:dihydrotestosterone ratio and CA 19-9 in the diagnosis of pancreatic cancer. The testosterone:dihydrotestosterone ratio (T:DHT) and the antigenic marker CA 19-9 were studied in the serum of 21 male patients with pancreatic cancer and 62 controls with other gastrointestinal malignancies or benign pancreatobiliary disease. Specificity of the T:DHT ratio was 98%, significantly better than the specificity of CA 19-9 at both a 37 U/ml cutoff level (61%) and at 100 U/ml (79%). Sensitivity of the T:DHT ratio was 67%, and that of CA 19-9, 71% and 90% at the upper and lower cutoff levels, respectively. False-negative results of the T:DHT ratio were found predominantly in cases of advanced pancreatic cancer, whereas all four stage I patients had an abnormal (less than 5) T:DHT ratio. These results suggest that the T:DHT ratio is a useful marker for pancreatic cancer in males. It can be used alone or in combination with CA 19-9, and should be further evaluated in the differential diagnosis of patients with the early stages of this disease.
Lipolytic response to metabolic stress in critically ill patients. OBJECTIVE: To measure whole-body lipolysis and fatty acid re-esterification in critically ill patients. DESIGN: The rates of appearance of glycerol and palmitic acid in blood plasma were measured by infusing stable isotope tracers [2H5]glycerol and [1-13C]palmitic acid, respectively. Energy expenditure was measured by indirect calorimetry. SETTING: Medical ICU of The University of Texas Medical Branch Hospital, a university-based referral center. PATIENTS: Five uninjured critically ill patients. Four patients were hospitalized because of respiratory insufficiency and one because of myocardial infarction. Three patients died during their hospitalization. INTERVENTIONS: Metabolic studies were performed in each patient after an overnight (12-hr) fast. MEASUREMENTS AND MAIN RESULTS: Mean +/- SE glycerol and fatty acid rates of appearance were 4.5 +/- 1.0 and 11.5 +/- 0.8 mumol/kg.min, respectively. The ratio of fatty acid to glycerol rate of appearance was 2.9 +/- 0.5. Resting energy expenditure was 132 +/- 6% of predicted. CONCLUSIONS: An accelerated rate of lipolysis is part of the metabolic response to severe stress, regardless of its etiology. Because the rate of fatty acid release far exceeded energy requirements, fatty acids that were not oxidized as fuel were re-esterified to triglyceride, presumably in the liver.
Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation and flutter. The present study was undertaken to reassess prospectively the immediate and long-term results of direct-current electrical cardioversion in chronic atrial fibrillation or atrial flutter, and to determine factors predicting clinical outcome of the arrhythmia after direct-current cardioversion. Two-hundred forty-six patients underwent direct-current electrical cardioversion and were followed during a mean of 260 days. Multivariate analysis was used to identify factors predicting short- and long-term arrhythmia outcome. Cardioversion was achieved in 70% of patients with atrial fibrillation and in 96% of patients with atrial flutter. Stepwise logistic regression analysis revealed that arrhythmia duration (p less than 0.001), type of arrhythmia (fibrillation vs flutter, p less than 0.02) and age (p less than 0.05) independently influenced conversion rate. On an actuarial basis, 42 and 36% of patients remained in sinus rhythm during 1 and 2 years, respectively. Multivariate regression analysis revealed that the type of arrhythmia (p = 0.0008), low precardioversion functional class (p = 0.002) and the presence of nonrheumatic mitral valve disease (p = 0.03) independently increased the length of the arrhythmia-free episode. Rheumatic heart disease shortened this period (p = 0.03). In conclusion, patients having a high probability of conversion together with a prolonged post-shock arrhythmia-free episode can be identified. This may improve the cost-benefit ratio of cardioversion.
Serum sialic acid levels in patients with oral and maxillofacial malignancy. Serum sialic acid levels were measured using the thiobarbituric acid method in 80 healthy subjects and in 40 patients with benign and 61 with malignant tumors in the oral and maxillofacial region. It was shown that the cancer group had statistically higher sialic acid levels than control group and the group with benign disease (P less than .05), but no significant difference was noted between the normal control group and the patients with benign tumor (P greater than .05). Serum sialic acid levels were significantly higher in the patients with stages III and IV cancer than in those individuals with stage I and II cancer, but no differences were seen between stages I and II, and between stages III and IV cancer patients (P greater than .05). There was also no difference when considering the anatomic site of the malignant lesion. Furthermore, during the serial sialic acid determination in cancer patients before and following treatment, the sialic acid levels usually declined with remission of the disease and increased with recurrence, metastasis, or a poor prognosis. We conclude from this study that the sequential measurement of sialic acid level is particularly useful in monitoring patients with oral cancer, and sialic acid may prove to be a valuable tumor marker in oral and maxillofacial malignancy.
Gallstone formation after major abdominal surgery. 84 patients underwent multiple abdominal ultrasound examinations over a median of 36 months (range 6-140). 11 had gallstones at their first ultrasound examination, and were excluded from further analysis. Of the remaining 73 patients, 12 of 47 who underwent major abdominal surgery had gallstones within 14-36 months of operation, compared with 0 of 26 who did not undergo such surgery. The cumulative prevalence of new gallstones within 3 years of major surgery was 28%; no new gallstones were seen from 36 to up to 140 months postoperatively. By univariate and logistic regression analysis, age and major abdominal surgery were the only significant clinical determinants for the appearance of gallstones during follow-up. The findings of this retrospective study indicate that major abdominal surgery may accelerate the development of gallstones in some patients. If confirmed in a prospective study, it may be possible to define groups at high risk of gallstones after surgery and to institute prophylactic measures.
Ultrasonography of acute abdominal pain in children. OBJECTIVE.--To determine the ability of ultrasonography to detect appendicitis and to identify other conditions responsible for symptoms in children with acute abdominal pain. DESIGN.--Cohort study. The accuracy of ultrasonographic results was assessed in relation to final diagnoses established by surgery or by composite clinical data and follow-up. SETTING.--Metropolitan, pediatric hospital; ambulatory and hospitalized patients. PATIENTS.--Consecutive sample of 178 pediatric patients who were referred for ultrasonography because of suspected acute appendicitis, but in whom the diagnosis could not be definitively established by clinical criteria. RESULTS.--Appendicitis was proven at surgery in 38 patients. Ultrasonography demonstrated the findings of appendicitis (noncompressible appendix with or without concomitant periappendiceal fluid collection or appendicolith) in 31 (82%) of these patients. Among the 140 children without appendicitis, other specific diagnoses were established by clinical, laboratory, and radiologic findings in 58 patients (including gynecologic diseases in 25, gastrointestinal tract abnormalities in 17, renal diseases in six, and extra-abdominal disease in 10). Ultrasonography aided in the diagnosis of other conditions in 34 (59%) of these 58 patients. No definitive clinical diagnosis was established in the remaining 82 patients. There were no false-positive results of ultrasonography. CONCLUSION.--Approximately half of children referred for suspected appendicitis will have a final diagnosis of abdominal pain of unknown origin. In the remainder, ultrasonography is useful, both to establish the diagnosis of appendicitis and to aid in diagnosing other causes of acute abdominal pain.
Preneoplastic alterations in nuclear morphology that accompany loss of tumor suppressor phenotype. Alterations of nuclear shape are frequently observed in tumor cells, but the genes controlling these changes and the stage in the neoplastic process at which they occur are unknown. We have studied nuclear shape changes in chemically immortalized, nontumorigenic Syrian hamster embryo cell clones that had either retained (supB+) or lost (supB-) the ability to suppress the tumorigenic phenotype when they were hybridized with a tumor cell line (BP6T). Quantitative morphometric analysis of the nuclei of cells from each of two pairs of supB+/supB- variants indicated that the nuclei of supB- cells were significantly more out of round than those of their corresponding supB+ clones. These data indicate that modification of nuclear structure may represent an early, preneoplastic event in multistep chemical carcinogenesis and that loss of a tumor suppressor gene function may regulate alterations in nuclear morphology.
Unusual diffuse pulmonary lymphatic proliferation in a young boy. We describe a 4-year-old boy who died of an unusual generalized pulmonary lymphatic proliferation. His condition cannot clearly be categorized with any of the previously described pulmonary lymphatic disorders.