shukoor65/lab-rag-model huggingface dataset:
Ossification of posterior longitudinal ligament of the cervical spine in non-Japanese Asians. "The Japanese disease," ossification of the posterior longitudinal ligament, is not confined to the Japanese only. A similar incidence of 0.8% was found in this study among non-Japanese Asians. Of 5167 patients who attended the Mount Elizabeth Hospital in Singapore for cervical spine complaints, 43 patients were found to have ossification of the posterior longitudinal ligament, forming the largest non-Japanese series. All but one patient were of Mongolian origin, and males were affected four times more commonly than females. Diabetes mellitus was present in 16%. There was a significant association between ossification of the posterior longitudinal ligament and calcification of other cervical paraspinal ligaments. It is suggested that a generalized tendency to calcification may be an important etiological factor in ossification of the posterior longitudinal ligament. Four of the patients required surgery, and in our experience, anterior spinal fusion with removal of the ossified ligament or multilevel laminoplasty gives satisfactory results.
Differential regulation of rasGAP and neurofibromatosis gene product activities. The ras-encoded p21ras proteins bind GTP very tightly, but catalyse hydrolysis to GDP very slowly. In humans, two genes encode proteins that stimulate this GTPase activity (GAP, or GTPase-activating proteins), one of relative molecular mass 120,000, referred to as p120-GAP, and another NF1-GAP, which is encoded by the neurofibromatosis type-1 gene. Both GAPs are widely expressed in mammalian tissues. Here we show that although they will both bind oncogenic mutants of p21ras, neither will stimulate their GTPase activity. NF1-GAP binds to the p21ras proteins up to 300 times more efficiently than p120-GAP. The two GAPs are inhibited to different extents by certain lipids: micromolar concentrations of arachidonate, phosphatidate and phosphatidylinositol-4,5-bisphosphate affect only NF1-GAP. This inhibition does not compete with p21ras, and lipid-inactivated NF1-GAP can still bind p21ras. We used the detergent dodecyl maltoside, which inhibits only NF1-GAP, to distinguish between the two activities in cell extracts and found both types present together in several mammalian cell lines. In contrast, GAP activity in extracts of Xenopus oocytes was not affected by dodecyl maltoside. By these criteria, the mammalian cells contain both GAP activities and the oocytes have only p120-like GAP activity. These results indicate that more than one GAP regulates p21ras in the same cell.
Anti-Ri: an antibody associated with paraneoplastic opsoclonus and breast cancer. The serum and cerebrospinal fluid (CSF) of 8 women with ataxia, 6 of whom also had eye movement abnormalities believed to be opsoclonus, were found to contain a highly specific antineuronal antibody we call anti-Ri. Seven of the 8 women also had or developed cancer: carcinoma of the breast in 5, adenocarcinoma in an axillary lymph node in 1, and carcinoma of the fallopian tube in 1. Four patients presented with the neurological disorder; the cancer was diagnosed first in the other 4. Immunohistochemical studies using serum or CSF from all 8 patients revealed a highly specific antibody interaction with central nervous system neuronal nuclei but not with glial or other cells; the titer ranged from 1:5,000 to 1:320,000 in serum and from 1:2,000 to 1:16,000 in CSF. Biotinylated IgG from the patients' serum reacted with the tumors of 3 of 4 patients with anti-Ri antibody but not with breast cancers from patients without anti-Ri antibody. Immunoblots against cerebral cortex neuronal extracts identified protein antigens of 55-kd and 80-kd relative molecular mass. Serum titers by immunoblot ranged from 1:500 to more than 1:40,000 and CSF titers, from 1:10 to 1:2,000. The relative amount of anti-Ri was always higher in CSF than in serum. The antibody was not present in sera from normal individuals; patients with breast cancer without opsoclonus; other patients with opsoclonus; or patients with other paraneoplastic syndromes related to breast, ovarian, or small-cell lung cancer. We conclude that the presence of anti-Ri antibody identifies a subset of patients with paraneoplastic ataxia and eye movement disorders (opsoclonus) who usually suffer from breast or other gynecological cancer; the antibody when present is a useful marker for an underlying malignancy.
Analgesic effect of intraarticular morphine after arthroscopic knee surgery BACKGROUND. Opioids can produce potent antinociceptive effects by interacting with local opioid receptors in inflamed peripheral tissue. In this study we examined the analgesic effects of the intraarticular, as compared with intravenous, administration of morphine after arthroscopic knee surgery. METHODS. In a double-blind, randomized trial, we studied 52 patients who had received one of four injections at the end of surgery. The patients in group 1 (n = 18) received 1 mg of morphine intraarticularly and saline intravenously; those in group 2 (n = 15), saline intraarticularly and 1 mg of morphine intravenously; those in group 3 (n = 10), 0.5 mg of morphine intraarticularly and saline intravenously; and those in group 4 (n = 9), 1 mg of morphine and 0.1 mg of naloxone intraarticularly and saline intravenously. The volume of the intraarticular injections was 40 ml, and that of the intravenous injections was 1 ml. After 1, 2, 3, 4, 6, and 24 hours, postoperative pain was assessed with a visual-analogue scale, a numerical-rating scale, and the McGill pain questionnaire. The need for supplemental analgesic agents, the patients' vital signs, and the occurrence of side effects were monitored. RESULTS. All pain scores were lower in group 1 than in group 2 at all times. The differences were significant (P less than 0.05) at three, four, and six hours (mean [+/- SD] visual-analogue score at six hours, 9 +/- 13 mm vs. 37 +/- 31 mm). The mean (+/- SD) consumption of supplemental analgesic medication per 24 hours was significantly lower in group 1 (36 +/- 51 mg of diclofenac and 1.2 +/- 3.4 mg of meperidine) than in group 2 (75 +/- 42 mg of diclofenac and 14 +/- 18 mg of meperidine, P less than 0.05). The visual-analogue scores in group 3 were slightly but not significantly higher than those in group 1 at all times except 6 and 24 hours after injection. The visual-analogue scores were significantly higher in group 4 than in group 1 one to four hours after injection (P less than 0.05), indicating that the analgesic effect of intraarticular morphine was reversible by naloxone. CONCLUSIONS. Low doses of intraarticular morphine can significantly reduce pain after knee surgery through an action specific to local opioid receptors that reaches its maximal effect three to six hours after injection.
Possible association between mutant frequency in peripheral lymphocytes and domestic radon concentrations To investigate whether previously found geographical correlations between leukaemia incidence and exposure to radon are reflected in a detectable mutagenic effect on individuals, the frequency of mutations in the hypoxanthine guanine phosphoribosyl transferase gene (hprt) in peripheral blood T lymphocytes was measured in subjects with known domestic radon concentrations. These concentrations were measured in December, 1989, in houses in Street, Somerset, UK, by passive alpha-track radon detectors. 20 non-smoking subjects aged 36-55 years were selected from the patient list at the local health centre on the basis of the radon concentrations in their homes--the range selected varied by a factor of ten. Blood samples for preparation of T lymphocytes were taken in July, 1990. There was a significant association between the log mutant frequency and radon concentration (t = 3.47, p less than 0.01). A second analysis of a further set of radon measurements (October, 1990, to January, 1991), in both living rooms and bedrooms, and repeated mutant frequency determinations also showed a significant relation, which remained significant even after exclusion of the highest frequency and adjustment for subject's age and cloning efficiency. These data must be regarded as preliminary and further more extensive studies should be done to determine whether the observed association is causal.
Oxygen delivery-dependent oxygen consumption in acute respiratory failure. OBJECTIVE: To investigate whether oxygen consumption (VO2) is dependent on oxygen delivery (DO2) in adult respiratory distress syndrome (ARDS) and non-ARDS acute respiratory failure. DESIGN: Intervention study of a consecutive sample of patients admitted to the ICU with the diagnosis of acute respiratory failure. SETTING: Tertiary care center. PATIENTS: Thirteen consecutive patients with a diagnosis of ARDS and 11 with a diagnosis of respiratory failure not due to ARDS. Patients were monitored with an oximetric pulmonary artery catheter and mechanically ventilated. INTERVENTIONS: DO2 was decreased by the application of positive end-expiratory pressure (PEEP) (20 cm H2O), and subsequently increased by an iv infusion of dobutamine (10 micrograms/kg.min). RESULTS: After the application of PEEP, DO2 decreased significantly in both groups. However, VO2 decreased significantly (p less than .01) only in the ARDS group. When dobutamine was infused, DO2 increased significantly (p less than .01) in both groups, but VO2 increased only in ARDS patients. DO2 correlated significantly with VO2 both in ARDS (r2 = .81, p less than .01) and in non-ARDS (r2 = .38, p less than .05) patients. The correlation coefficient was significantly higher for ARDS than for non-ARDS patients. Comparing the slopes of the regression lines, a stronger dependency of VO2 on DO2 was found in ARDS than in non-ARDS respiratory failure (p less than .001). The oxygen extraction ratio correlated with DO2 in non-ARDS patients (r2 = .49, p less than .05), but not in ARDS patients. CONCLUSIONS: VO2 is dependent on DO2 over a wide range of DO2 values in acute respiratory failure. This dependency phenomenon is much stronger in ARDS than in respiratory failure due to other causes. Due to the abnormal dependency of VO2 on DO2, changes in the oxygenation status may not be reflected by changes in mixed venous oxygen saturation in ARDS.
Effect of metoclopramide on angiotensins, aldosterone, and atrial peptide during hypoxia. The coupling of aldosterone with renin is altered during acute hypoxemia. We measured the various components of the renin-angiotensin system and the plasma levels of immunoreactive atrial natriuretic factor (iANF) during room air and hypoxic gas-mixture breathing before and after administration of metoclopramide, a competitive antagonist of dopamine. Seven resting volunteers were studied 1 wk apart under room air and hypoxic conditions (inspired O2 fraction 0.12). During hypoxemia, the release of aldosterone induced by metoclopramide was significantly smaller. This change was associated with a slight increase in iANF and with a decrease in plasma angiotensin II levels, without any change in immunoreactive blood angiotensin I concentrations. Plasma electrolytes and blood acid-base status did not show relevant changes, nor did blood pressure and heart rate. We conclude that the decreased aldosterone concentrations seen under hypoxemia are related to decreased angiotensin II levels. Other influences, such as elevated ANF, may also mediate this effect.
Randomized, double-masked study of cyclosporine compared to prednisolone in the treatment of endogenous uveitis. Fifty-six patients with bilateral sight-threatening noninfectious intermediate or posterior uveitis participated in a randomized double-masked study of the use of cyclosporine vs prednisolone in their treatment. Applying the end-point definitions, visual acuity or vitreal haze improved in only 13 of 28 (46%) patients in each group. The macular edema resolved in seven of 15 patients of the cyclosporine-treated group, and in ten of 16 patients of the prednisolone-treated group (P = .376). Patients whose therapies failed both cyclosporine and prednisolone trials were treated with both drugs, which resulted in additional patient improvements. Secondary effects were observed in both therapeutic alternatives, the most notable being alterations in serum creatinine concentration and hypertension with the dosage of cyclosporine used.
Establishment of permanent renal tubule cell lines by infection with the wild-type and a thermosensitive mutant of the simian virus 40. This study summarizes the properties of rabbit renal tubule cell lines transformed by the simian virus 40 (SV40). By infection with the wild type SV40, it was possible to establish three different cell lines exhibiting the main functions of proximal (RC.SV1), thick ascending limb-distal (RC.SV2), and collecting (RC.SV3) tubules. Another cell line infected with a thermosensitive mutant of SV40 (RC.SVtsA58) was highly sensitive to arginine vasopressin when cells were cultured at the restrictive temperature of 39.5 degrees C, suggesting they derived from principal cells of the collecting tubule.
Hospital mortality and long-term survival after pulmonary resection in the elderly. We have studied the hospital mortality and long-term survival in two groups of patients: those between 50 and 69 years of age (group 1, n = 136) and those older than 70 years of age (group 2, n = 43). The two groups were similar in terms of the distribution of histological type and postsurgical staging. The patients were treated by either lobectomy or pneumonectomy; the lobectomy rate was similar in both groups: 61% and 51% (not significant). Hospital mortality for group 1 was 4.4% and for group 2, 6.9%. Mortality was higher in both groups after pneumonectomy compared with lobectomy, but this was not significant (group 1, 6.2% versus 1.9%; group 2, 9.1% versus 4.7%). Hospital mortality after pulmonary resection was greater in the elderly, but this was not significant (lobectomy: 1.9% [group 1] versus 4.7% [group 2]; pneumonectomy: 6.2% [group 1] versus 9.1% [group 2]. The overall long-term survival at 2 and 4 years was 62.3% and 50.0% for group 1 and 72.5% and 66.6% for group 2. We suggest that the operative risk in the elderly is not prohibitive and the long-term results are acceptable. Patients should not be denied operation on the basis of age alone.
Subtotal parathyroidectomy for secondary hyperparathyroidism in chronic renal failure. Twenty-seven patients on chronic haemodialysis and with secondary hyperparathyroidism underwent subtotal parathyroidectomy during the period 1985-1989. The operation was indicated by severe clinical symptoms and evidence of radiological abnormalities not responsive to conservative treatment (low phosphorus diet, phosphate binding substances, oral calcium and vitamin D). If despite intensive medical management, inadequate control of parathyroid hyperplasia continues surgical intervention becomes necessary. Ultra-sonography was performed pre-operatively in all 27 cases and detected 42 of 99 glands (42.5 per cent). Also scintigraphy was carried out in every patient but it gave a relatively low detection rate (24.5 per cent). Surgery was followed by improvement in 20 patients and progression of hyperparathyroidism in seven cases. Three of the seven patients failed to improve after subtotal parathyroidectomy, necessitating a re-intervention; the remaining four responded sufficiently to medical therapy. From our experience we conclude that subtotal parathyroidectomy for renal hyperparathyroidism is recommended.
Telephone versus face-to-face mode for collecting self-reports of sequences of behavior. This study compared telephone vs face-to-face interviews as ways to collect self-reported sequences of daily activities. Twenty-seven persons with spinal cord injury in a rehabilitation hospital participated. The Self-Observation and Report Technique was used to obtain, in the participants' own words, two reports per week of 24-hour sequences of activities. One report per week was given over the telephone and one in person. Each behavior was coded for activity, assistance, companions, and locations. Nineteen measures assessing independence, level and diversity of activity, mobility, and social contacts were derived from the last four interviews for each participant. Differences in the measures derived from each mode were tested. Accuracy was assessed by comparing the self-reports to data on activities recorded by trained observers. Measures from the two modes did not differ, nor did the percent agreements with observation data. Investigators can use the more convenient and efficient telephone mode with confidence.
Adjuvant therapy in early breast cancer. Breast cancer is the most common malignancy in women. Screening mammography can detect cancer in its early stages, when it is potentially curable. Adjuvant chemotherapy is of major benefit in node-positive patients. It is also beneficial in certain node-negative patients with a high risk of breast cancer recurrence; these patients should be identified and offered adjuvant therapy or enrolled in a clinical trial.
Treatment of cardiogenic shock with the Hemopump left ventricular assist device. A multiinstitutional study is in progress to evaluate the Hemopump in the treatment of cardiogenic shock. Fifty-three patients with refractory cardiogenic shock were selected for Hemopump assistance. The hemodynamic definition of cardiogenic shock included (1) a cardiac index of less than 2.0 L.min-1.m-2, (2) pulmonary capillary wedge pressure of greater than 18 mm Hg, and (3) a systolic blood pressure of less than 90 mm Hg or a left ventricular work index of less than 1,500 g-m.m-2.min-1. The Hemopump was successfully inserted in 41 of 53 patients (77.3%). A significant improvement in the hemodynamic status was seen during Hemopump assistance. A minimal level of hemolysis was observed. No leg ischemia was observed. The 30-day overall survival of the Hemopump group was 31.7%. Criteria establishing indications for use and clinical utility are proposed. We conclude that the Hemopump provides significant hemodynamic support of the patient in cardiogenic shock allowing for recovery from ventricular stunning in marginal ventricles, and that in select patients the Hemopump may offer a major improvement in survival over conventional therapy.
Relation of symptoms to contractility and defect size in infants with ventricular septal defect. Forty-two infants with a ventricular septal defect (VSD) (21 asymptomatic and 21 symptomatic) were compared with 17 control infants to determine if symptoms of congestive heart failure (i.e., tachypnea/poor growth) were due to depressed contractility or defect size, or both. Echocardiographic indexes of defect size, left ventricular performance (shortening fraction), preload (left ventricular end-diastolic dimension), afterload (left ventricular end-systolic wall stress) and contractility (the relation between velocity of circumferential fiber shortening and wall stress) were measured. Clinical assessment included measurement of weight and respiratory rate. Pulmonary and systemic blood flow were assessed in 17 symptomatic and 3 asymptomatic patients by cardiac catheterization. Although there was no significant difference in age, the symptomatic group had significantly lower weight (5.5 +/- 2.9 vs 7.3 +/- 2.3 kg, p less than 0.05) and a higher respiratory rate (53 +/- 14 vs 43 +/- 6 breaths/min, p less than 0.05), compared with control subjects. The mean pulmonary to systemic blood flow ratio in the symptomatic group was 2.9:1. Preload indexed for body surface area was significantly higher in the groups with a VSD compared with control subjects (asymptomatic, 8.5 +/- 1.7 cm/m2; symptomatic, 9.1 +/- 1.7 cm/m2; control subjects, 6.8 +/- 1.1 cm/m2; p less than 0.05). Shortening fraction, afterload and contractility were not significantly different among all groups. A defect size greater than 0.5 cm (or defect size indexed for body surface area greater than 1.8 cm/m2) was predictive of the presence of symptoms. It is concluded that contractility is normal in infants with a VSD. Symptoms may be related to pulmonary congestion.
Bladder outlet obstruction treated with transurethral ultrasonic aspiration. One-year follow-up on 59 patients. Fifty-nine males with bladder outlet obstruction were treated with transurethral ultrasonic aspiration of the prostate. Utilizing a 26.5F urethral sheath, surgery was accomplished with a 10F, 0-700-micron-vibration-level ultrasonic tip with an excursion rate of 39 kHz. Complete removal of the adenoma was accomplished followed by transurethral electrocautery biopsies of both lateral lobes to compare pathologic specimens. One year follow-up revealed satisfactory voiding patterns in 57 of 59 men (96%). Bladder neck contractures developed in 2 men. Pathologic comparisons showed 100 percent correlation between aspirated and TUR specimens (56 BPH, 3 adenocarcinoma). Forty-seven men were active sexually preoperatively (6 with inflatable penile prostheses). Post ultrasonic aspiration, 46 men had erectile function similar to preoperative levels with 1 patient suffering erectile dysfunction. Forty men (85%) had antegrade ejaculation while 7 (15%) experienced retrograde or retarded ejaculation. No patients were incontinent.
Histopathology of childhood pneumonia in developing countries. Acute lower respiratory infection in children is a major cause of morbidity and mortality in developing countries. Viral and bacterial agents incite characteristic host responses at the level of the bronchi, bronchioles, alveolar walls, and air spaces that correlate with the clinical course. A systematic review of histopathologic features will enhance the understanding of the pathogenetic mechanisms and cofactors that influence the disease process, particularly how tissue injury may be influenced by nutritional status and access to antibiotics. Research priorities include immunologic assessment, micronutrient assays, and standardized autopsies in developing countries. DNA probes for organisms and immunocytochemical identification of cell markers in tissue promise a new era in microscopic visualization of pathogen-host interactions. International collaborative research between ministries of public health and medical universities must be encouraged as a means of providing technical assistance and of advancing new knowledge. Systematic standardized autopsy studies from multiple geographic areas may help define pathologic mechanisms, monitor the natural history of disease, and evaluate interventions in diverse populations.
Human papillomavirus type 16 DNA in anal cancers from six different countries. An association between anal squamous cell carcinoma and human papillomavirus (HPV) type 16 DNA has been documented in the UK. If HPV type 16 is an important aetiological factor in the development of this tumour it would be expected to occur in anal cancer tissues from other parts of the world. In this study a series of 173 anal squamous cell carcinoma tissue samples from five centres around the world have been examined by DNA hybridisation for HPV type 16 DNA sequences. HPV type 16 DNA was found in 50 of 173 (29%) of these. The prevalence of HPV associated anal squamous cell carcinoma was significantly lower in tissue from India and South Africa than in the Swiss, Polish, or Brazilian samples. HPV associated anal squamous cell carcinoma does occur in other countries and further investigations of the prevalence of these tumours in association with other HPV types are required.