shukoor65/lab-rag-model huggingface dataset:
MR imaging of the portal venous system: value of gradient-echo imaging as an adjunct to spin-echo imaging. We evaluated the use of gradient-echo (GRE) as an adjunct to spin-echo (SE) MR imaging of the portal venous system. GRE imaging was performed in 31 subjects, 15 normal volunteers and 16 patients with documented portal venous disease (15 cases) or suspected disease (one case). Eight of 16 patients had venous thrombosis, five had focal thrombus, and three had complete occlusion. Six patients had extrinsic venous compression by tumor. Of the two other patients, one had an arteriovenous fistula and the other a falsely positive angiogram, suggesting portal vein occlusion. In normal subjects, GRE scans had excellent visualization of the portal venous system with high intravascular signal compared with surrounding tissues. Nine (60%) of 15 normal subjects and three patients had an artifact consisting of a curvilinear area of decreased signal that could mimic clot. In three of five patients with focal thrombus, clot was identified on GRE but not on SE images. In all three patients with occlusion, SE and GRE images demonstrated similar findings. In five of the six patients with extrinsic venous compression by tumor, SE and GRE studies showed similar findings. Of the two patients, an arteriovenous fistula was seen on GRE MR in one, and in the other, patency of the left portal vein was seen on SE and GRE images after angiography had suggested portal vein occlusion. Collateral vessels were seen in nine of 16 patients. In five of nine cases, GRE MR demonstrated more extensive collaterals than did SE MR. In summary, GRE MR provides a useful adjunct to standard SE MR imaging. Benefits include high contrast between vascular structures and surrounding tissues, reduced motion artifact, and rapid scanning within a breath-hold.
Posttraumatic stress disorder following recent-onset psychosis. An unrecognized postpsychotic syndrome. Clinical experience with psychotic patients early in the course of their illness suggested that symptoms of posttraumatic stress disorder (PTSD) may not be uncommon after recovery from an acute psychotic episode. Thirty-six patients recovering from an acute psychotic episode within 2 to 3 years of onset of their illness were assessed as inpatients and followed up on two occasions during the year after discharge. The prevalence of PTSD was found to be 46% at 4 months and 35% at 11 months, measured by a questionnaire linked to DSM-III criteria. The relationships between negative symptomatology and PTSD symptoms and between depressive symptomatology and PTSD symptoms were also examined; a significant correlation was found only for the latter. The psychopathological, preventive, and therapeutic implications of these findings are discussed, and future research strategies are proposed.
The effect of quadriceps excision on functional results after distal femoral resection and prosthetic replacement of bone tumors. Although resection and reconstruction with a prosthesis is an accepted form of treatment for tumors of the distal femur, minimal effort has been made to correlate the functional result with the degree of adjacent muscle excision. From 1983 to 1986, 65 patients had distal femoral resection and prosthetic reconstruction. Ten patients had only the vastus intermedius excised (Group A), 30 patients had excision of the vastus intermedius plus either the vastus medialis or lateralis (Group B), nine patients had only the rectus femoris spared (Group C), and 16 patients had the entire quadriceps excised or conversion of the previous arthrodesis (Group D). Based on the rating system of the Musculoskeletal Tumor Society, satisfactory results were obtained in 70% of Group A patients (30% excellent and 40% good), with no poor results. In group B, 80% had good or excellent results and 7% poor results. In Group C, 78% of the patients had good results but no excellent results, whereas Group D had only 50% satisfactory results. The parameters that most often led to functional impairment were restricted motion and inadequate extensor powers. Muscle transfers, however, (flexors to extensors) were effective only in Group C patients. With proper technique and prosthetic design, satisfactory results can be achieved after distal femoral resection and prosthetic reconstruction, even after extensive quadriceps excision.
Swedish Agency for Research Cooperation with Developing Countries. Prospects for public health benefits in developing countries from new vaccines against enteric infections. The symposium participants concluded that vaccines with even moderate efficacy can be highly useful to prevent large numbers of severe illness episodes and deaths and that the decision of whether to initiate a vaccine program should be based on measures or estimates of public health effectiveness rather than only on protective efficacy. Studies of protective efficacy are of course critical to establish the vaccine's biologic activity, but additional aspects of public health effectiveness are also crucial in making these decisions. First-generation vaccines are available against typhoid, cholera, and soon rotavirus diarrhea, and vaccines against enterotoxigenic E. coli diarrhea and shigellosis are under development. The problems related to enteric diseases are enormous; the vaccines may soon be produced at low cost and promise to be relatively more easy to distribute than most previous vaccines. The number of illnesses and deaths averted from vaccine programs are potentially great. Pilot programs using the new vaccines should urgently be considered in areas where the disease burden is high, and steps should be taken to monitor effectiveness of the intervention in these programs. Such studies of vaccine effectiveness and costs in a "real world" situation are an essential step of the research process and should be used to guide the organization of larger-scale programs. Finally, many of the necessary research and development activities relevant to public health vaccinology must address country-specific problems. Developing countries should consider the role of vaccine-related research among the priorities for their essential national health research and build the necessary capabilities in applied and basic medical sciences and in the social sciences.
Determination of growth fraction in advanced prostate cancer by Ki-67 immunostaining and its relationship to the time to tumor progression after hormonal therapy. Reliable predictors of response for prostate cancer patients undergoing hormonal therapy are lacking. This study investigates the possibility that tumor proliferation rates might predict tumor behavior for these patients. The growth fraction of metastatic prostate cancer biopsy specimens obtained before androgen withdrawal therapy was evaluated by Ki-67 antibody immunohistochemical study to determine whether a higher tumor growth fraction was associated with a shorter time to tumor progression after therapy. The percentage of Ki-67-positive malignant epithelial nuclei in the primary tumors of 17 patients ranged from 1.7% to 7.5% (median, 2.5%). When patients were divided into two response groups according to the median time to progression, poor responders (time to progression less than 20 months) and good responders (greater than or equal to 20 months) had similar growth fractions (3.5 +/- 0.5% versus 3.1 +/- 0.6% Ki-67-positive nuclei, respectively). However, when patients were divided into two groups based on the median growth fraction, patients with a high growth fraction (greater than 2.5% Ki-67-positive nuclei) tended to have a shorter time to progression (median, 10 months) than patients with a low (less than 2.5%) growth fraction (median time to progression, 25 months), although statistical significance was not reached. Despite this interesting trend, Ki-67 immunostaining was not accurate to predict the time to progression in individual patients undergoing hormonal therapy. Reliable prediction of growth rates may require measurement of both cell proliferation and cell death rates.
Donor hearts with impaired hemodynamics. Benefit of warm substrate-enriched blood cardioplegic solution for induction of cardioplegia during cardiac harvesting. Brain-dead donors frequently show circulatory deterioration and often require so much inotropic support that the donor heart is of questionable value. This experimental study quantifies the cardiac metabolic consequences of brain death and the role of warm blood cardioplegic solution for induction of cardioplegia to improve the quality of potential donor hearts with impaired hemodynamics. Twelve dogs were subjected to brain death by interrupting cerebral blood flow (ligation of innominate artery, carotid arteries, and superior vena cava) and were followed up for as long as 6 hours. Each showed progressive hemodynamic deterioration, necessitating inotropic support (dopamine, calcium, and epinephrine) and large amounts of volume replacement (hetastarch; Hespan) to support the circulation (maintain mean arterial blood pressure greater than 60 mm Hg). Biopsy specimens were taken after 6 hours, or when irreversible ventricular fibrillation occurred, and were analyzed for adenosine triphosphate, creatine phosphate, glycogen, glutamate, and lactate. In six dogs the aorta was then clamped, and a 10-minute infusion of warm (37 degrees C) substrate-enriched aspartate/glutamate blood cardioplegic solution (with the dog's own blood) was given by roller pump to simulate warm induction during the harvesting process. Biopsies were then repeated. Myocardial metabolism, expressed as percent of control values, during brain death was characterized by the following: (1) moderate energy depletion (adenosine triphosphate fell 25% +/- 8%, creatine phosphate fell 55% +/- 15%; p less than 0.05 versus control: mean +/- standard error of the mean); (2) substrate depletion (tissue glutamate fell 48% +/- 9.5%, glycogen fell 66% +/- 7.5%; p less than 0.05 versus control: mean +/- standard error of the mean); and (3) evidence of anaerobic metabolism (lactate increased 374% +/- 95%; p less than 0.05 versus control: mean +/- standard error of the mean). Warm induction of blood cardioplegia in these energy- and substrate-depleted ischemic hearts showed (1) return of creatine phosphate levels to normal (113% +/- 16.8%), (2) replenishment of glutamate (201% +/- 24% of control; p less than 0.05 versus control: mean +/- standard error of the mean), and (3) 43% +/- 14% reduction in myocardial lactate content; (p less than 0.05 versus brain-dead animals). These data suggest that brain-dead donors requiring inotropic support sustain energy and substrate depletion and ischemic damage that can be reversed by a brief period of induction of cardioplegia with a warm substrate-enriched blood cardioplegic solution before harvesting.(ABSTRACT TRUNCATED AT 400 WORDS).
Treatment with recombinant human tumor necrosis factor-alpha protects rats against the lethality, hypotension, and hypothermia of gram-negative sepsis. Tumor necrosis factor (TNF) is a peptide secreted by macrophages in response to endotoxin that can produce many of the changes seen in septic shock. After cecal ligation and puncture (CLP) rats gradually develop tachycardia, hypotension, tachypnea, and hypothermia. At 5 h post-CLP, rats have a peak in serum levels of endotoxin and 60% of rats have blood cultures that grow Gram-negative rods (Escherichia coli and Klebsiella pneumonia). At 20 h post-CLP all rats develop positive blood cultures. Serum levels of TNF are not reproducibly measurable in rats following CLP. Rats undergoing CLP have a 50-80% mortality with deaths usually occurring 24-72 h postinjury. Repetitive (twice daily x 6 d) i.p. injection of sublethal doses of recombinant human TNF-alpha (100 micrograms/kg) to rats undergoing CLP 1 d after the treatment period resulted in a significant reduction in mortality compared to control rats previously unexposed to rTNF (P less than 0.03). Animals treated with rTNF had no hypotension or hypothermia after CLP and regained normal food intake faster than control rats. 12 h after CLP the gene expression for manganous superoxide dismutase (MnSOD), an inducible mitochondrial metalloenzyme responsible for cellular resistance to injury from toxic reactive oxygen species, was higher in livers of rats treated with rTNF suggesting that the TNF treatment augmented expression of this protective enzyme. Unlike MnSOD, expression of the gene for copper-zinc SOD was not affected by CLP or rTNF treatment. The results suggest that prior treatment with recombinant TNF can ameliorate the lethality, hypotension, hypothermia, and anorexia of Gram-negative sepsis in rats and that the mechanism may be related to enhanced hepatic expression of the gene for MnSOD. Repeated administration of recombinant TNF may be a strategy to minimize mortality and morbidity of Gram-negative sepsis.
Adequate crystalloid resuscitation restores but fails to maintain the active hepatocellular function following hemorrhagic shock. Studies have shown that active hepatocellular function is depressed early after trauma-hemorrhage and persists despite resuscitation with two or three times (x) the volume of maximum bleedout (MB) with lactated Ringer's solution (LR). However, it is not known if a larger volume of fluid resuscitation corrects this dysfunction. To study this, rats were bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of the MB volume was returned in the form of LR, and then resuscitated with 4x or 5x the volume of MB with LR. Three doses of indocyanine green (ICG) were given intravenously and [ICG] measured in vivo using an in-vivo hemoreflectometer. The initial velocity of the clearance of ICG was calculated. Maximal velocity of the clearance (Vmax: the number of functional ICG receptors) and kinetic constant (Km: the efficiency of the active transport) were determined from the Lineweaver-Burk plot. Vmax decreased during hemorrhage, was restored to control levels at 0-4 hours after resuscitation, but decreased at 4-8 hours after resuscitation despite restoration of cardiac output following resuscitation with 5x LR. This could be the result of increased TNF release. The Km also decreased during hemorrhage, but increased at 0-1.5 hours and remained at control levels even 4-8 hours after resuscitation. Thus the failure of Vmax to remain at control levels following adequate fluid resuscitation may form the basis of cellular dysfunction and multiple organ failure after severe hemorrhagic shock.
Analyses of 200 lymphadenectomies in patients with penile carcinoma. From 1972 to 1987, 200 consecutive lymphadenectomies were performed in 112 patients with squamous cell carcinoma of the penis. A Gibson incision provided exposure of the iliac and inguinal lymph nodes with a low morbidity rate (5% flap necrosis, 15% wound infection, 16% lymphedema and 9% lymphocele). The controversy surrounding the necessity of iliac lymphadenectomy is discussed, since 305 iliac lymph nodes examined did not have metastatic invasion.
Peripheral white blood cell counts and bacterial meningitis: implications regarding diagnostic efficacy in febrile children. In order to investigate the clinical value of peripheral white blood cell variables for the diagnosis of bacterial meningitis among young, febrile children, we compared total peripheral white counts, total segmented neutrophil counts, total band counts, and the ratio of immature-to-total neutrophils (I:T ratio) among 46 children with bacterial meningitis, 130 children with aseptic meningitis, and 56 febrile children with culture confirmed extrameningeal bacterial infection. Children with bacterial meningitis were comparable to those with aseptic meningitis with respect to median total white blood cell counts and median total segmented neutrophil counts but had a significantly higher median total band count (1760/microliters vs 378/microliters, P = 0.0001) and a significantly higher median I:T ratio (0.40 vs 0.09, P less than 0.001). In contrast, children with bacterial meningitis were comparable to those with an extrameningeal bacterial infection with respect to median total band count but had a significantly lower median total peripheral white count (10,650/microliters vs 15,300/microliters, P = 0.0013), a lower median total segmented neutrophil count (4511/microliters vs 6796/microliters, P = 0.023), and a significantly higher median I:T ratio (0.40 vs 0.15, P less than 0.001). Children with meningitis who were bacteremic at presentation had a significantly lower total white cell count (P = 0.001) and significantly higher I:T ratio (P = 0.005) when compared with children who had an extrameningeal infection and concurrent bacteremia at presentation.
Pancreatic-portal vein fistula with disseminated fat necrosis treated by pancreaticoduodenectomy. I have reported the case of a 62-year-old man with chronic alcoholic pancreatitis and a rare pseudocyst-portal vein fistula. Even though he experienced no abdominal symptoms, he had severe metastatic fat necrosis manifested as subcutaneous fat necrosis, polyarthritis, medullary bone necrosis, and mental status changes. Remote tissue destruction continued until relief was gained by pancreaticoduodenectomy and repair of the necrotic portal vein. Disseminated fat necrosis is a rare syndrome that can be the only presenting feature in patients with pancreatitis and pancreatic cancer. Early recognition and treatment of the underlying pancreatic disease may decrease the high morality rate associated with this syndrome.
The use of intraaortic balloon pumping as an adjunct to reperfusion therapy in acute myocardial infarction. The Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group. To assess the risk and possible benefits of use of the percutaneous IABP in patients given thrombolytic therapy as treatment for acute myocardial infarction, we prospectively evaluated 810 consecutive patients entered into the TAMI trials. During hospitalization the 85 patients treated with the IABP had more cardiac risk factors, were slightly older (58 vs 56 years), and more often had anterior infarction (62% vs 38%). At acute cardiac catheterization, patients treated with the IABP also had more multivessel coronary disease (67% vs 43%), more frequent TIMI grade 0 or 1 flow (44% vs 28%), lower global ejection fraction (40% vs 52%), and worse regional infarct (-3.2 vs -2.5 SD/chord) and noninfarct (-0.67 vs +0.36 SD/chord) zone function. Although mortality rates (32% vs 4%) and in-hospital complications were greater in patients treated with the IABP, a greater improvement in global (delta ejection fraction: +1.9% vs +0.7%) and noninfarct zone (delta SD/chord: +0.11 vs -0.09) left ventricular function was observed in patients treated with the IABP at 1-week follow-up angiography. In addition, no reinfarction or reocclusion of the infarct-related artery occurred while patients were being treated with the IABP. These results suggest that the IABP may have a specific role after thrombolytic therapy in treating patients at high risk for reocclusion or at high risk for hemodynamic deterioration because of large infarction or critical stenoses in coronary vessels supplying the noninfarct zone.
Postoperative computed tomography three months after lumbar disc surgery. A prospective single-blind study. In a prospective single-blind study, 60 patients surgically treated for lumbar disc herniation underwent clinical examination and computed tomography preoperatively and 3 months after surgery. At follow-up (58 patients; median, 31 months; range, 21-37 months), 29 patients had an excellent outcome (51%), 20 improved (33%), and 9 were unchanged or worse (16%). Dural or radicular scar tissue was present by computed tomography in 88% of the patients, but the findings could not be correlated with the clinical outcome. Recurrent or persistent disc herniation was found in 9% of the patients. The clinical outcome of patients with abnormal computed tomography did not differ significantly from patients without this finding. A relation between facet joint degeneration and less successful clinical outcome was demonstrated. Computed tomography (without contrast) 3 months after surgery gave little information which could be correlated with the clinical outcome. Patients with an excellent outcome had all degrees of intraspinal scar tissue.
Fragile X genotype characterized by an unstable region of DNA. DNA sequences have been located at the fragile X site by in situ hybridization and by the mapping of breakpoints in two somatic cell hybrids that were constructed to break at the fragile site. These hybrids were found to have breakpoints in a common 5-kilobase Eco RI restriction fragment. When this fragment was used as a probe on the chromosomal DNA of normal and fragile X genotype individuals, alterations in the mobility of the sequences detected by the probe were found only in fragile X genotype DNA. These sequences were of an increased size in all fragile X individuals and varied within families, indicating that the region was unstable. This probe provides a means with which to analyze fragile X pedigrees and is a diagnostic reagent for the fragile X genotype.
Treatment of bilateral intrahepatic stones with high duct strictures through selective central hepatic resection. Bilateral intrahepatic duct stones with strictures, more common in the Orient than elsewhere, are difficult to access surgically. The results of surgical procedures have not been generally successful and are attended by a high postoperative complication and recurrence rate. We report the treatment of 30 patients with intrahepatic calculi and high duct strictures by means of selective central hepatic resection without dissection of the major vessels at the hilum. Central hepatic resection provided satisfactory access to the primary and secondary confluences of the intrahepatic ducts, allowed removal of residual stones and ascariasis, and permitted correction of multiple strictures. Twenty-nine patients so treated were followed for a mean of 32 months after operation. No patients developed recurrent fever, biliary colic, or jaundice after the operation. The technique is therefore recommended as an effective alternative to extensive hepatic lobectomy in the treatment of the intrahepatic calculi with multiple strictures.
Neonatal schizencephaly: comparison of brain imaging. Schizencephaly is a regional disturbance of cerebral hemisphere formation occurring at 3-5 months gestation; neonatal presentation is uncommon. Three neonates with schizencephaly were evaluated with cranial ultrasonography (US), unenhanced computed tomography (CT), and magnetic resonance imaging (MRI) examinations. Common findings in US, CT, and MRI include parasylvian and midline clefts, size asymmetries of the basal ganglia and thalamus, cerebral parenchymal volume loss, ventriculomegaly, ventricular diverticula, and absence of the septum pellucidum. MRI and CT were superior to US in detecting calcification, gyral and sulcal abnormalities, and parasylvian clefts. MRI alone demonstrated homolateral absence of the sylvian vasculature, small medullary pyramids, low position of the fornix, and the thinning of the corpus callosum. Although US appears adequate as a screening test, MRI best defines the precise pathoanatomic findings of neonatal schizencephaly and allows for the prediction of neurologic outcomes in affected newborns.