shukoor65/lab-rag-model huggingface dataset:
Acid secretory changes and early relapse following duodenal ulcer healing with ranitidine or sucralfate. Controversial aspects relating to acid secretory changes following duodenal ulcer healing, and the effect of histamine-2 (H2)-receptor blockers on such changes are discussed. Recent studies comparing the effects of ranitidine or sucralfate on changes in the acid secretory responses in the healing of duodenal ulcers are described, and the relevance of these changes to early relapse considered. The duration of therapy and timing of acid-secretory studies and endoscopies are standardized in all studies, but the acid-secretory parameters vary. These comprised acid secretory responses to graded doses of an intravenous infusion of pentagastrin or histamine, sham-feeding responses, and basal and nocturnal acid secretion. In all studies, healing with sucralfate was associated with a significant decrease in the various parameters of acid secretion. In the ranitidine-healed groups, no appreciable decrease was noted and there was, indeed, a significant increase in nocturnal acid secretion. Routine endoscopies performed 4-6 weeks after documented ulcer healing showed a recurrence of 3 of the 32 (9%) sucralfate-healed and in 14 of the 35 (40%) ranitidine-healed ulcers. Increased acid secretory responsiveness following duodenal ulcer healing was strongly correlated with subsequent early relapse.
Effects of calcium antagonists on glomerular hemodynamics and structure in experimental hypertension. The RK, DS, and UNX SHR rats are related models of progressive renal disease characterized by the presence of severe systemic hypertension and reduction in renal mass. In these models, glomerular injury is related to increased glomerular pressure and to kidney and glomerular hypertrophy. As summarized in Table 1, administration of a calcium antagonist reduces the prevalence of glomerular sclerosis in all three models. Calcium antagonists have many effects that might tend to reduce renal injury. Similar to the ACE inhibitors, they may reduce PGC, although a protective effect has been observed in some models despite persistence of marked glomerular capillary hypertension. Calcium antagonists also appear to inhibit compensatory renal growth. The observation that these drugs lessen injury in experimental hypertension has important implications for the treatment of patients with hypertension and renal disease. However, widespread use of calcium antagonists specifically to prevent kidney damage should await the results of controlled clinical trials.
Acute fulminant hepatic failure. Fulminant hepatic failure is the rapid onset of life-threatening hepatic decompensation in patients who have no previous history of liver disease. This condition has a multifactorial etiology, including viral hepatitis and drug toxicity. At this time there is no specific therapy for FHF. However, early diagnosis and treatment of the complications--in particular, cerebral edema--may prolong survival and prevent irreversible neurologic complications. Once the diagnosis has been made, patients with FHF should promptly be transferred to a specialized liver care unit where liver transplantation is available. Liver transplantation is now the treatment of choice for patients with clinical characteristics suggesting a poor chance of survival.
Problems encountered with the Bethesda System: the University of Iowa experience. This paper provides a descriptive summary of 1 year's experience with the Bethesda Cytologic Classification System at the University of Iowa Hospitals and Clinics. Cytotechnologists and pathologists criticized the failure of the new classification system to provide microscopic criteria for the following categories: adequacy of the smear (satisfactory, less than optimal, unsatisfactory), atypical squamous cells of undetermined significance, atypical glandular cells of undetermined significance, and inflammation-associated changes. Clinicians criticized the "less than optimal" category and the reporting of koilocytosis, moderate dysplasia, and endometrial cells. Suggestions for modifying the Bethesda System include: eliminating the less than optimal response, defining what constitutes an unsatisfactory smear, eliminating the terms low-grade and high-grade squamous intraepithelial lesion, and changing the reporting of endometrial cells.
Microglandular adenosis of the breast. An immunohistochemical comparison with tubular carcinoma. Microglandular adenosis (MA) of the breast is a benign, disorganized proliferation of glands lined by a single layer of cells. As such, differential diagnosis between MA and tubular carcinoma may be challenging in selected cases. A panel of antibodies was applied to 10 cases of MA and 10 of tubular carcinoma to investigate the potential benefit of immunohistochemistry in the separation of these lesions and the possible role of myoepithelial cells in MA. The luminal cells in nine cases of MA were surrounded by a cuff of muscle-specific actin-reactive cells, which also coexpressed cytokeratin and vimentin. The immunophenotype of these cells is characteristic of myoepithelial differentiation, which was heretofore thought to be lacking in MA. This finding demonstrates that myoepithelial cells are indeed present in MA subjacent to luminal epithelial cells; moreover, it distinghuishes MA from tubular carcinoma, all examples of which were actin negative in this analysis. In addition, circumferential type IV collagen deposition was observed around constituent glands of MA in nine cases but was lacking in all tubular carcinomas. Other markers included in this evaluation (S100 protein, gross cystic disease fluid protein 15, carcinoembryonic antigen, estrogen receptor protein) were of no differential diagnostic value.
Propranolol in the prevention of the first hemorrhage from esophagogastric varices: A multicenter, randomized clinical trial. The Boston-New Haven-Barcelona Portal Hypertension Study Group. To assess the effectiveness of propranolol in the prevention of initial variceal hemorrhage, a double-blind, randomized trial was carried out in three centers. Patients with cirrhosis (78% alcoholic), hepatic venous pressure gradients greater than 12 mm Hg and endoscopically proven esophageal varices were randomly assigned to propranolol (51 patients) or placebo (51 patients). Of the 102 patients, 58% were Child's class A, 34% were Child's class B and 8% were Child's class C. Daily dosage was determined by the administration of progressively increasing doses of propranolol with the hepatic vein catheter in place to achieve a 25% decrease in hepatic venous pressure gradient, a decrease in hepatic venous pressure gradient to less than 12 mm Hg or a decrease in resting heart rate to less than 55 beats/min. During a mean follow-up period of 16.3 mo, 11 patients in the placebo group (22%) bled from esophageal varices compared with 2 in the propranolol group (4%) during a mean period of 17.1 mo (p less than 0.01). Three additional patients (6%) in the placebo group bled from portal hypertensive gastropathy compared with none in the propranolol group. Propranolol appeared effective in preventing bleeding from large varices. Eleven deaths (22%) occurred in the placebo group compared with eight deaths (16%) in the propranolol group (NS). The mean dose of propranolol was 132 mg/day, and the median dose was 80 mg/day. Using a compliance index (pill count, clinic attendance, alcohol and propranolol levels and alcohol history), 81% of the propranolol patients and 77% of the placebo patients were considered compliant. Complications severe enough to require cessation of therapy occurred in eight patients (16%) in the propranolol group and four in the placebo group (8%) (NS). We conclude that propranolol effectively prevents the first variceal hemorrhage in patients with alcoholic cirrhosis and large esophageal varices but does not improve survival.
Stump pressure, the contralateral carotid artery, and electroencephalographic changes. Electroencephalographic (EEG) monitoring and measurement of stump pressure are the most widely employed methods of assessing the risk of cerebral ischemia during carotid endarterectomy. The status of the contralateral carotid artery has also been thought to influence the need for placing a shunt. The relationship of EEG monitoring, stump pressure, and the contralateral carotid artery has not been completely delineated. We retrospectively reviewed these three variables in 113 patients undergoing 124 carotid endarterectomies. The contralateral artery was classified as occluded, stenotic (greater than 50% decrease in diameter), or nonstenotic. There was a 48% incidence of EEG changes with contralateral occlusion, 18% with stenosis, and 21% with nonstenotic arteries (p = 0.014). There was a 73% incidence of EEG changes when the stump pressure was less than 25 mm Hg, 32% when the stump pressure was 25 to 50 mm Hg, and 2% when the stump pressure was greater than 50 mm Hg (p less than 0.001). There was no significant difference in the mean stump pressure for patients with occlusion (43.8 mm Hg), stenosis (44.7 mm Hg), or nonstenotic contralateral arteries (51.3 mm Hg). All patients with contralateral occlusion and a stump pressure less than 25 mm Hg had EEG changes. No patient with a stump pressure greater than 50 mm Hg and a patent contralateral artery had EEG changes. Although the incidence of EEG changes in the majority of patients was not accurately predicted by the stump pressure and the status of the contralateral carotid artery, stump pressure less than or equal to 50 mm Hg was sensitive, identifying 97% of patients with EEG changes.
Malignant lymphoma of the urinary bladder. A case with signet-ring cells simulating urachal adenocarcinoma. We describe a malignant lymphoma involving the dome and anterior wall of the urinary bladder in an elderly woman. The initial biopsy showed a malignant neoplasm of uncertain cell type. Because the clinical presentation was most compatible with urachal adenocarcinoma, an extensive resection was performed. Microscopically, the excised tumor was composed of large lymphoid cells with isolated and clustered signet-ring cells. Immunohistochemical analysis established the B-cell phenotype of the neoplasm, and electron microscopy of the signet-ring cells revealed endoplasmic reticulum-bound inclusions consistent with immunoglobulin. Primary malignant lymphomas of the urinary bladder are rare, and, to our knowledge, we report the first example with signet-ring cells. We emphasize this histopathologic finding because of the potential for confusion with urachal adenocarcinoma.
Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience. Epidural spinal cord stimulation by means of chronically implanted electrodes was carried out on 121 patients with pain of varied benign organic etiology. In 116 patients, the pain was confined to the back and lower extremities and, of these, 56 exhibited the failed-back syndrome. Most patients were referred by a pain management service because of failure of conventional pain treatment modalities. Electrodes were implanted at varying sites, dictated by the location of pain. A total of 140 epidural implants were used: 76 unipolar, 46 Resume electrodes, 12 bipolar, and six quadripolar. Patients were followed for periods ranging from 6 months to 10 years, with a mean follow-up period of 40 months. Forty-eight patients (40%) were able to control their pain by neurostimulation alone. A further 14 patients (12%), in addition to following a regular stimulation program, needed occasional analgesic supplements to achieve 50% or more relief of the prestimulation pain. Pain secondary to arachnoiditis or perineural fibrosis following multiple intervertebral disc operations, when predominantly confined to one lower extremity, seemed to respond favorably to this treatment. Uniformly good results were also obtained in lower-extremity pain secondary to multiple sclerosis. Pain due to advanced peripheral vascular disease of the lower limbs was well controlled, and amputation below the knee was delayed for up to 2 years in some patients. Pain due to cauda equina injury, paraplegic pain, phantom-limb pain, pure midline back pain without radiculopathy, or pain due to primary bone or joint disease seemed to respond less well. Patients who responded to preliminary transcutaneous electrical nerve stimulation generally did well with electrode implants. Notable complications included wound infection, electrode displacement or fracturing, and fibrosis at the stimulating tip of the electrode. Three patients in this series died due to unrelated causes. Epidural spinal cord stimulation has proven to be an effective and safe means of controlling pain on a long-term basis in selected groups of patients. The mechanism of action of stimulation-produced analgesia remains unclear; further studies to elucidate it might allow spinal cord stimulation to be exploited more effectively in disorders that are currently refractory to this treatment modality.
Cine magnetic resonance imaging for diagnosis of right coronary arterial-ventricular fistula. In two cases of coronary arterial-ventricular fistula, detailed morphologic evaluation of the affected coronary artery was performed by MRI. Cine-MRI enabled both identification of the fistula and evaluation of the direction of shunt blood flow. Thus, MRI is a valuable noninvasive procedure in the anatomic and physiologic diagnosis of coronary arterial fistula.
Root of the superior mesenteric artery in pancreatitis and pancreatic carcinoma: evaluation with CT To determine if changes involving the root of the superior mesenteric artery are specific for neoplasm, the authors retrospectively reviewed 173 computed tomographic (CT) examinations of patients with proved pancreatitis (103 examinations) and pancreatic ductal adenocarcinoma (70 examinations). Streaky infiltration of the fat surrounding the root was seen in 27 of 56 examinations of acute pancreatitis, in four of 24 examinations of chronic pancreatitis, in 12 of 23 examinations of pancreatitis complicated by abscess, and in 25 of 70 examinations of pancreatic carcinoma. Periarterial lymph nodes were visible in 14 with acute pancreatitis, in three with chronic pancreatitis, in six with pancreatic abscess, and in 11 with pancreatic carcinoma. A focal mass extended to within 1 cm of the root in 10 with acute pancreatitis, in two with chronic pancreatitis, in four with pancreatic abscess, and in 24 with pancreatic carcinoma; the mass obliterated the periarterial fat in seven with acute pancreatitis, in one with pancreatic abscess, and in 18 with pancreatic carcinoma. Circumferential encasement occurred in one with chronic pancreatitis, in four with pancreatic abscess, in 14 with pancreatic carcinoma, and in none with acute pancreatitis; nearly all cases of encasement revealed loss of periarterial fat. Thus, these indicators are not specific for neoplasm.
Study of belching ability in antireflux surgery patients and normal volunteers. The ability to belch was evaluated by a novel test, after gaseous stomach distension to standard volume, in 16 patients after antireflux surgery and nine healthy volunteers. A structured assessment of dyspeptic symptoms was also carried out in both groups. Repeat studies in volunteers showed acceptable reproducibility for the new test of belching capacity (within-subject coefficient of variance 4.5 per cent). After antireflux surgery, patients had lower volume individual belches (median(range) 27.5(0-104) ml in patients versus 76(15-165) ml in volunteers; P less than 0.02) and belched less gas within 1 h of the stimulus than volunteers (median(range) 205(0-1363) ml in patients versus 456(45-818) ml in volunteers; P less than 0.05). Belching frequency was similar in both groups. The incidence and severity of symptoms were unrelated to belched gas volumes.
Platelet-free calcium and vascular calcium uptake in ethanol-induced hypertensive rats. This study examined the effect of moderate ethanol intake on systolic blood pressure, platelet cytosolic free calcium, aortic calcium, and rubidium-86 uptake in Wistar-Kyoto rats. Twelve Wistar-Kyoto rats, aged 6 weeks, were given 5% ethanol in drinking water the first week followed by 10% ethanol in drinking water for the next 6 weeks. Twelve control animals were given regular tap water. Systolic blood pressure in the ethanol-treated rats was significantly higher (p less than 0.05) than that in controls after 1 week and remained higher throughout the study. At 13 weeks of age, platelet cytosolic free calcium and calcium uptake by aortas were significantly higher (p less than 0.001) in ethanol-treated animals as compared with those in controls. Ethanol intake did not affect aortic ouabain-sensitive 86Rb uptake. The in vitro effect of ethanol on calcium-45 and 86Rb uptake was also investigated in aortas of untreated Wistar-Kyoto rats at 13 weeks of age. In vitro ethanol (2.5-20 mmols/l) did not significantly affect 45Ca and 86Rb uptake in rat aortas. The increases in systolic blood pressure, platelet cytosolic free calcium, and vascular calcium uptake suggest that increases in cytosolic free calcium and calcium uptake mechanisms are associated with ethanol-induced hypertension.
Estimating the likelihood of severe coronary artery disease. PURPOSE: To determine which clinical characteristics obtained by a physician during an initial clinical examination are important for estimating the likelihood of severe coronary artery disease, and to determine whether estimates based on these characteristics remain valid when applied prospectively and in different patient groups. PATIENTS AND METHODS: We examined clinical characteristics predictive of severe disease in 6,435 consecutive symptomatic patients referred for suspected coronary artery disease between 1969 and 1983. RESULTS: Eleven of 23 characteristics were important for estimating the likelihood of severe coronary artery disease. A model using these characteristics accurately estimated the likelihood of severe disease in an independent sample of 2,342 patients referred since 1983. The model also accurately estimated the prevalence of severe disease in large series of patients reported in the literature. CONCLUSIONS: These findings suggest that the clinician's initial evaluation can identify patients at high or low risk of anatomically severe coronary artery disease. Cost-conscious quality care is encouraged by identifying patients at higher risk for severe coronary artery disease who are most likely to benefit from further evaluation.
Cost and benefit of secondary prophylaxis for Pneumocystis carinii pneumonia. OBJECTIVE--To determine the relative cost and benefit of aerosolized pentamidine and the combination product of sulfamethoxazole and trimethoprim sulfate as secondary prophylaxis for Pneumocystis carinii pneumonia. DESIGN--A Markov-based cost-benefit analysis was performed. Drug efficacies, toxicities, and mortality rates were drawn from the current literature. SETTING--Hypothetical. PATIENT POPULATION--Patients infected with the human immunodeficiency virus who had had at least one episode of P carinii pneumonia. INTERVENTIONS--Regimen 1 required the use of aerosolized pentamidine as the sole first-line prophylactic agent in all patients. Regimen 2 required the use of sulfamethoxazole-trimethoprim in all patients who had no history of a toxic reaction to the drug; only patients with a history of toxic effects and those who developed toxic effects while receiving the drug would receive aerosolized pentamidine. Regimen 3 required that no secondary prophylaxis be given. MAIN OUTCOME MEASURES--Net cost, median patient survival, and 5-year survival for each regimen and for regimens 1 and 2 compared with regimen 3. MAIN RESULTS--Regimen 2 was dominant, with a net cost of $6332 per patient and a median survival of 2.050 years. Compared with no prophylaxis, regimen 2 resulted in a savings of $16,503 per patient and a 0.696-year increase in median survival. Compared with regimen 1, regimen 2 resulted in a savings of $2904 and a 0.067-year increase in median survival. CONCLUSIONS--Secondary prophylaxis for P carinii saves money and extends survival. Current data suggest that sulfamethoxazole-trimethoprim should be given whenever it can be tolerated. Use of aerosolized pentamidine as a first-line agent would result in a modest increase in cost and a decrease in life expectancy.
Epidemiological characteristics of subarachnoid hemorrhage in an urban population. Several risk factors for unfavorable outcome from subarachnoid hemorrhage (SAH) have been identified. The prevalence of such risk factors varies among ethnic groups and among men and women. The influence of ethnic background and gender as factors in the outcome after SAH has not been adequately studied and is the focus of the present investigation. Outcome in 145 consecutive patients was dichotomized as good and moderately disabled vs severely disabled, vegetative, and dead. A multiple logistic regression model was used to examine the factors of gender, ethnic group (white and non-white), age, admission neurological grade, pre-existing hypertension, and intravenous drug abuse. Our data reveal that hypertensive, white males, with a history of intravenous drug abuse, have a high risk of unfavorable outcome following SAH. These observations are important for the design and interpretation of future studies relating to SAH.
Iodine-125 interstitial implants as salvage therapy for recurrent gynecologic malignancies. Twenty-one patients with the diagnosis of recurrent gynecologic pelvic malignancy from various primary sites were treated with iodine-125 (I-125) interstitial implants. Eighteen of these patients had been treated with a combination of surgery and radiation therapy for their primary malignancies and 90% had responded. Seventy-five percent had complete local responses. The overall survival time, volume-response relationship, and complications are discussed and the radioresponse of various histologic types is presented.
Effect of nitroglycerin on coronary collateral function during exercise evaluated by quantitative analysis of thallium-201 single photon emission computed tomography. A noninfarcted, entirely collateral-dependent myocardial region provides an opportunity to assess the effect of nitroglycerin on coronary collateral function during exercise. Stress thallium-201 computed tomography was performed in seven patients with effort angina and no history of myocardial infarction, both before and after nitroglycerin (0.3 mg). All patients had single-vessel disease with total or subtotal (99% with delay) occlusion of proximal left anterior descending coronary artery and well-developed collaterals. The pressure-rate product, mean blood pressure, and heart rate at peak exercise did not differ before and after nitroglycerin. The size of the perfusion defect and the severity of ischemia during exercise estimated by quantitative analysis of thallium-201 single photon emission computed tomography were significantly less after nitroglycerin administration (extent score: 23 +/- 17 vs 7 +/- 9, p less than 0.01; severity score: 20 +/- 22 vs 3 +/- 4, p less than 0.05). The pressure-rate products at peak exercise did not differ before and after nitroglycerin, which suggested that the reduction in perfusion defect size was unlikely to be the result of decreased myocardial oxygen consumption. These results suggest that nitroglycerin improved coronary collateral function during exercise and thus prevented exercise-induced myocardial ischemia.