shukoor65/lab-rag-model huggingface dataset:
Histological grading of squamous cell carcinoma of the penis: a new scoring system. A system of histological grading based on retrospective analysis of 239 patients with squamous cell carcinoma of the penis is presented. A new scoring system with 4 histological grades was used. The results of this study confirm previous reports that penile cancer is usually a highly (50%) or moderately (29%) differentiated squamous cell carcinoma. Poorly differentiated carcinomas and cancers of other types are very rare. The new grading system was found to be practical and a correlation between histological grade, clinical findings and prognosis was established. Patients with grade 1 tumours had an exceptionally favourable prognosis, with more than 80% being long-term survivors; for these patients, treatment with delayed side effects should be avoided and new forms of treatment should be explored.
Effect of diphtheria-tetanus-pertussis immunization on prolonged apnea or bradycardia in siblings of sudden infant death syndrome victims. To determine whether the incidence of apnea or bradycardia increased after the first diphtheria-tetanus-pertussis (DTP) immunization in 100 subsequent siblings of victims of sudden infant death syndrome, we examined data obtained from floppy disk recordings attached to apnea-bradycardia monitors for episodes of apnea lasting 15 seconds or longer and episodes of bradycardia lasting 10 seconds or longer. The data were divided into three periods: (1) 10 days before the first DTP immunization was received (pre-DTP period), (2) 10 days immediately after the DTP (DTP period), and (3) 10 days after the DTP period (post-DTP period). Seventeen infants had at least one episode of prolonged apnea or prolonged bradycardia either before or after the 30-day study period (eight before only, eight after only, and one before and after). None of the infants had episodes of apnea lasting 15 seconds or more or bradycardia lasting 10 seconds or more during the pre-DTP or DTP period. One episode of apnea, 16 seconds long, and one episode of bradycardia lasting 11 seconds occurred in the post-DTP period. These results failed to confirm the clinical impression that DTP immunizations are associated with an increased frequency and severity of prolonged apnea. They also place in question the utility of assessing an infant's response to a DTP immunization to determine continued risk of apnea and bradycardia before home monitoring is discontinued.
A phase II trial of high-dose cisplatin and dacarbazine. Lack of efficacy of high-dose, cisplatin-based therapy for metastatic melanoma. Cisplatin and dacarbazine are used widely in the treatment of metastatic melanoma. To evaluate high-dose cisplatin and dacarbazine, 32 patients with metastatic melanoma were treated with cisplatin 50 mg/m2 and dacarbazine 350 mg/m2 daily for three days repeated at 28-day intervals. Their median age was 43.5 years (range, 25 to 73 years), and their median Karnofsky performance status was 80% (range, 70% to 100%). Measurable and evaluable disease sites (number of patients) included lymph nodes (22), lung (17), soft tissue (16), liver (13), bone (seven), spleen (four), adrenal gland (three), skin (three), and other sites (five). Patients received a median of two cycles of therapy (range, one to eight cycles). Thirty patients were evaluable for response. No complete responses were observed. Five patients had a partial response (17%; 95% confidence interval, 3% to 30%) for 16+, 12+, 7, 6.5, and 3 months. Responding sites of disease included lymph nodes (five of 22), lung (three of 17), and soft tissue (two of 16). Hematologic toxicity (Grade greater than or equal to 3) included neutropenia (16 of 32 patients, 30 of 90 cycles), thrombocytopenia (eight of 32 patients, 12 of 90 cycles), and anemia (five patients). Nine episodes of neutropenia and fever were seen in four patients; two had bacteremia. Nonhematologic toxicity (Grade greater than or equal to 3) included hypotension (two patients), nausea and vomiting (four), neuropathy (two), ototoxicity (four), and hypomagnesemia (nine). The low objective response rate and severe toxicity of this regimen preclude its standard use in patients with metastatic melanoma. A review of cisplatin-based therapy in metastatic melanoma suggests that there is no dose-response relationship. The use of high-dose cisplatin (greater than 100 mg/m2) in the treatment of metastatic melanoma is not recommended.
Circulatory abnormalities and compensatory mechanisms in heart failure. Knowledge of the basic alterations of central hemodynamics in congestive heart failure has failed to explain many aspects of this important syndrome. Increasing attention has recently been paid to compensatory and adaptive mechanisms occurring after the initial insult. Thus, new insights have been gained into the pathophysiology of contraction of hypertrophied myocardium and changes of adrenergic receptors in the myocardium due to chronically increased cardiac sympathetic tone. The role of the renin-angiotensin-aldosterone system in early and advanced congestive heart failure has been further elucidated, and the role of the vasodilating atrial natriuretic peptide is undergoing further definition. New results further clarify the mechanisms leading to breathlessness and muscular fatigue in congestive heart failure, with emphasis shifting from the traditional concept of the importance of increased filling pressures to changes to the peripheral circulation and exercising muscles. Although progress has been made in understanding of the pathophysiology of congestive heart failure, many aspects are still poorly understood and await clarification.
The eyes of child abuse victims: autopsy findings. The authors studied 77 pairs of eyes removed from children who had died of suspected child abuse. Forty-seven of the cases had retinal hemorrhages. Those showing retinal hemorrhages were younger children and had fewer other stigmata of child abuse. Hemorrhages are more likely to occur in cases where the child was shaken or swung than in those with severe direct head trauma. The authors recommend that examination of the eyes be included in the autopsies of all small children who died without an obvious cause of death. Experience in both processing and reading of ocular material is necessary for reliable results.
Crossing failure in PTCA: mind the deflated balloon profile! An attempt to reposition an Integra PTCA balloon-on-a-wire failed although the whole stenosed segment could be crossed before inflation. After careful removal the device showed a grossly altered shape. Deflated balloon profiles, quite different from the initial shape, can determine the outcome both in dissections and in multilesion cases.
Suprascapular nerve lesions at the spinoglenoid notch: report of three cases and review of the literature. Lesions of the suprascapular nerve can occur at the supraspinatus notch (SSN) or at the spinoglenoid notch (SGN). Electromyographic (EMG), evaluation of the infraspinatus, and especially the supraspinatus muscles distinguishes SGN from SSN lesions. Three cases of SGN lesions, which are more common than SSN lesions, are presented.
Ifosfamide continuous infusion without mesna. A phase I trial of a 14-day cycle. Twenty patients received 27 courses of ifosfamide administered as a 24-hour continuous infusion for 14 days without Mesna. The goal of the study was to deliver a dose rate and total cumulative dose of ifosfamide that would be comparable to standard bolus or short-term infusions administered with Mesna. Dose escalations proceeded from 200 to 300, 400, 450, 500, and 550 mg/m2/d. Four patients developed transient microscopic hematuria at 400, 450, and 500 mg/m2/d. There were no instances of macroscopic hematuria. At 550 mg/m2/d, three patients experienced nonurologic toxicity; confusion (1), nausea (1), and Grade 2 leukopenia (1). The recommended dose of 500 mg/m2/d delivers a total dose of 7 g/m2 per cycle, which is comparable to that delivered in clinical practice for bolus or short-term infusion. Because few patients received multiple courses over time, the cumulative effects are indeterminate in the present trial. The frequency and predictability of hematuria are not precise, and at least daily monitoring by urine Hematest is essential, adding Mesna to the infusate in patients with persistent hematuria. The protracted infusion schedule for ifosfamide permits convenient outpatient administration without Mesna and reduces the drug cost of clinical usage of this agent by up to $890 per cycle. Clinical activity was demonstrated in a single patient, but a comparative trial of standard bolus schedules with the protracted infusion schedule will be necessary to determine if the clinical effectiveness of the drug is maintained.
VpreB gene expression in hematopoietic malignancies: a lineage- and stage-restricted marker for B-cell precursor leukemias. We show here that analysis of VpreB gene transcription can be a specific way to identify acute leukemias of cells at very early stages of B-cell development. Northern blot analysis of RNAs from 63 leukemia samples showed that VpreB RNA was present in malignancies of precursor B cells, the expression being a feature of both common acute lymphoblastic leukemia (ALL) (CD10+) and null ALL (CD10-). It was absent from malignancies of mature B cells (surface Ig positive), from acute leukemias of the T-cell lineage and granulocyte-macrophage lineages, and from normal tonsil B and T lymphocytes. Chronic myeloid leukemia blast crises of the B-precursor-cell type expressed the VpreB gene while myeloid blast crises did not. VpreB RNA was also expressed in the neoplastic cells of one of three patients with acute undifferentiated leukemias. These data show that VpreB RNA expression is a marker of the malignant forms of precursor B cells, and that it appears at least as early as cytoplasmic CD22 and CD19 in tumors of the B-cell lineage.
Argon laser photocoagulation for neovascular maculopathy. Five-year results from randomized clinical trials. Macular Photocoagulation Study Group. With completion of follow-up of all patients enrolled in three randomized clinical trials of argon laser photocoagulation of extrafoveal choroidal neovascular membranes secondary to senile (age-related) macular degeneration, ocular histoplasmosis, or idiopathic causes, the Macular Photocoagulation Study Group has demonstrated that laser treatment of such lesions is beneficial in preventing or delaying large losses of visual acuity for at least 5 years. In eyes with senile (age-related) macular degeneration as the underlying cause, the relative risk of losing six or more lines of visual acuity from the baseline level among untreated eyes (n = 117) compared with laser-treated eyes (n = 119) was 1.5 from 6 months through 5 years after entry (P = .001). In addition, after 5 years, untreated eyes had lost a mean of 7.1 lines of visual acuity, while laser-treated eyes had lost 5.2 lines. Recurrent neovascularization had been observed in 54% of laser-treated eyes by the end of the 5-year follow-up period. Among eyes with ocular histoplasmosis, untreated eyes (n = 130) had 3.6 times the risk of laser-treated eyes (n = 132) of losing six or more lines of visual acuity (P less than .0001). Also, untreated eyes had lost a mean of 4.4 lines of visual acuity after 5 years, compared with only 0.9 lines lost by laser-treated eyes. Among laser-treated eyes, recurrent neovascularization had been observed in 26% by 5 years after enrollment.
Classical conditioning of ventilatory responses in humans. A classical conditioning experiment, in which an auditory stimulus was paired with a hypoxic stimulus, was carried out on 34 normal subjects assigned to two groups (experimental and control). Each subject took part in one session divided into two phases, acquisition and test. In the acquisition phase, eight hypoxic and eight auditory stimuli were paired in the experimental group and unpaired in the control group. In the test phase, which was identical for the two groups, the hypoxic stimuli were suppressed and three purely auditory stimuli were presented. Significant differences between the two groups in ventilatory response to these auditory stimuli provided evidence for conditioning. In the control group, no significant changes were elicited by the auditory stimuli, whereas a conditioned increase in total cycle duration was observed in the experimental group. The conditioned response closely resembled the first component of the hypoxic response. Analysis of the pattern of the conditioned response, along with postexperimental interviews, strongly suggests that this response was not mediated by volitional factors.
Peritoneal adhesion formation after lysis: inhibition by polyethylene glycol 4000. Peritoneal adhesions cause much long-term postoperative morbidity. This study evaluates the efficacy of polyethylene glycol (PEG) 4000 in reducing adhesion reformation after lysis. Adhesions were induced, by abrasion, in 111 Sprague-Dawley rats at a first laparotomy. At a second operation, 10 days later, these adhesions were graded and lysed, after which the animals received one of the following solutions intraperitoneally: 5 per cent PEG 4000 (n = 21), 25 per cent PEG 4000 (n = 23), 32 per cent dextran 70 (n = 22) or isotonic saline (n = 25), or were left as an untreated control group (n = 20). When the reformed adhesions were graded after a further 10 days 5 per cent PEG 4000 was found to be the only solution that inhibited adhesion reformation. The adhesions that reformed in the other four test groups were significantly worse than when they were first graded (P less than or equal to 0.033 for all groups). Therefore 5 per cent PEG 4000 may be useful in clinical practice for the reduction of adhesion formation after lysis.
The effect of preoperative therapy on the histologic features of Wilms' tumor. An analysis of cases from the Third National Wilms' Tumor Study. Preoperative chemotherapy is being used with increasing frequency in the US for the management of selected children with Wilms' tumor, despite relatively limited knowledge as to the effects of such therapy on tumor histologic features. The authors reviewed pathologic material from all preoperatively treated unilateral Wilms' tumors registered on the third National Wilms' Tumor Study. Preoperative therapy was associated with increased ambiguity of tumor stage. The prevalence of anaplasia in the 83 evaluable specimens was similar to, although slightly increased over, that in comparable high-stage untreated Wilms' tumors (11% versus 5% to 8%), and it appeared to retain its adverse connotations. These data also suggest that alterations of tumor character and distribution by therapy provide useful prognostic information. All 17 children whose residual viable tumor was limited to intrarenal sites at the time of resection were alive and disease-free at last follow-up. Extensive (greater than 90%) tumor necrosis, low mitotic activity, and high degrees of differentiation of residual tumor were also associated with favorable outcomes. Although careful utilization of preoperative chemotherapy can be of value in children with otherwise difficult-to-manage Wilms' tumors, the potential benefits of preoperative tumor bulk reduction must be weighed against the risk of overtreatment or undertreatment as a result of increased ambiguity of tumor stage.
Efficacy of ampicillin versus trimethoprim-sulfamethoxazole in a mouse model of lethal enterococcal peritonitis. Lethal enterococcal peritonitis in mice was used to compare trimethoprim-sulfamethoxazole (TMP-SMX) therapy with ampicillin therapy. Peritoneal fluid showed a 10(3)-CFU decrease in enterococci with ampicillin compared with TMP-SMX. Mortality of the untreated mice was 100%, compared with 40% for ampicillin and 95% for TMP-SMX, despite adequately measured levels in serum and peritoneal fluid.
Respiratory complications and hypoxic episodes during inhalation induction with isoflurane in children. We have studied the incidence of respiratory complications and hypoxic episodes during inhalation induction with isoflurane in 75 healthy unpremedicated children. Problems occurred less frequently when 4% isoflurane in oxygen was used from the outset than with traditional techniques using nitrous oxide and a gradually increasing inspired vapour concentration. The improved results observed with the former method may be secondary to more rapid uptake of vapour so that the second stage of anaesthesia characteristic of anaesthetic ethers is shortened considerably.
Resection and reconstruction of the carotid bifurcation with polytetrafluoroethylene grafts; operative technique. Preliminary results in 25 procedures and indications. Although carotid endarterectomy is the standard procedure, the purpose of this paper is to describe a new surgical technique and indicate its role in the surgery of cervical cerebrovascular disease. The technique consists of resection of the pathologic carotid artery bifurcation followed by its total replacement with a bifurcated thin-wall polytetrafluoroethylene (PTFE) graft constructed by the surgeon. Prosthetic graft reconstruction of the carotid bifurcation (PGRCB) was performed in 21 patients (25 procedures) from November 1984 to May 1987. Many patients were over 70 years old. The indications for surgery were transient ischemic attacks (TIA)'s in 10 patients (high-grade stenosis), established stroke with mild deficit in 3 patients (high-grade stenosis). Eight patients (high-grade stenosis) were asymptomatic and 4 had vertebro-basilar symptoms. In 11 procedures the indications were the same as for standard carotid endarterectomy (significant stenosis and/or ulcerated plaque). In 14 cases, the procedure was justified by extensive lesions involving a long segment of the internal carotid artery (2 restenoses, 12 calcified lesions). In the perioperative period, there were no deaths and no TIA's. The 25 procedures were assessed one month postoperatively by ultrasonic imaging and venous substraction angiography. All the grafts were patent with perfect restoration of the carotid bifurcation anatomy. Systematic follow-up study was carried out in 1987. Three patients had died of non-neurologic causes and one was lost to study. The remaining 19 procedures were evaluated with an average follow-up of 19 months (range 7 to 32 months). The patients were asymptomatic and all the grafts remained patent including one stenosis (greater than 50%) at the common carotid artery anastomosis. Because recent studies have documented a much higher rate of technical defects or recurrent stenosis after carotid endarterectomy, we believe that PGRCB merits consideration, particularly in difficult endarterectomies, and in recurrent carotid stenosis. Furthermore it seems acceptable to advocate PGRCB in aneurysms of the internal carotid artery and in post-irradiation arteritis.
Effects of antiarrhythmic drugs on canine atrial flutter due to reentry: role of prolongation of refractory period and depression of conduction to excitable gap. Antiarrhythmic drugs prolong the effective refractory period and depress conduction. To determine the exact role played by these two electrophysiologic effects in the termination of reentry, the effects of disopyramide, flecainide, propafenone and E-4031, a new class III drug, were examined in a canine model of atrial flutter (cycle length 120 +/- 4 to 131 +/- 3 ms) caused by reentry. Atrial flutter was induced in 32 anesthetized open chest dogs after placement of an intercaval crush. The excitable gap ranged from 9 +/- 2% to 11 +/- 4% of the basic flutter cycle length. The effective refractory period in the reentrant circuit during atrial flutter was estimated by subtracting the excitable gap from the basic flutter cycle length. Prolongation of flutter cycle length by the test drugs was proportional to the interatrial conduction time (r = 0.87, p less than 0.001). Atrial flutter was terminated by each test drug in all dogs except for flecainide and propafenone in one dog each. E-4031 prolonged the refractory period during atrial flutter to 129 +/- 6 ms, which did not differ significantly from the flutter cycle length immediately before termination (134 +/- 4 ms). The refractory period during atrial flutter after injection of the other drugs was shorter than the flutter cycle length before termination of atrial flutter (for example, flecainide 126 +/- 5 vs. 179 +/- 11 ms, p less than 0.01).
Phantom-related phenomena after rectal amputation: prevalence and clinical characteristics. Phantom sensations are well known and almost inevitable sequels to limb amputation, whereas similar phenomena are only rarely described after rectum amputation (phantom rectum). Our study attempted to assess the frequency and character of phantom rectum. All surviving patients (n = 22), who had undergone abdominoperineal surgical resection of the rectum in the period 1980-1986 at our clinic, were interviewed by a standard questionnaire and underwent a physical examination. Sixty-eight per cent of the patients experienced a sensation of a missing rectum (phantom rectum), and in 27% of these or 18% of all patients this sensation was painful (phantom pain). The most common symptoms were sensations of flatus and/or faeces in a normal rectum, phantom flatus or phantom faeces. The phantom pains were described as either pricking and shooting or like haemorrhoids or hard stools that would rupture the rectum. Neither age, sex, preoperative pain, the Duke classification of the tumour nor the healing of the perineal wound seemed related to the likelihood of phantom rectum. The pathophysiological mechanisms underlying phantom-related phenomena following amputation have not yet been elucidated. This study describes a relatively unknown phantom-related clinical entity after amputation and may thus contribute to the understanding of this phenomenon.
Induction of apoptosis during normal and neoplastic B-cell development in the bursa of Fabricius. The lymphoid cells of embryonic bursal follicles are engaged in rapid growth and preimmune diversification of immunoglobulin genes. Disruption of follicular architecture by mechanical dispersion of these cells in short-term tissue culture was accompanied by continued cell division and extensive cell death by apoptosis. Apoptosis was suppressed in parallel cultures of intact follicles. gamma Radiation also triggered extensive apoptosis in embryonic bursal follicles within a few hours. Preneoplastic bursal stem cell populations induced by a v-myc oncogene were hypersensitive to induction of apoptosis by follicular dispersion and radiation. In contrast, tumor progression in v-myc- and v-rel-initiated bursal neoplasms was accompanied by development of resistance to induction of apoptosis. A programmed cell death pathway can be activated during normal B-cell development in the bursa, and alterations in the expression of this pathway accompany neoplastic change in this system.
Chronic perineal pain related to sacral meningeal cysts. Chronic perineal pain is an often encountered problem that is difficult to evaluate. Based on a series of 17 patients in whom urological, gynecological, and anorectal pathology was excluded, the authors compared magnetic resonance imaging (MRI) with computed tomographic (CT) scan with myelography in the investigation of chronic perineal pain. After a clinical neurological examination, patients underwent radiodiagnostic imaging of both techniques. Thirteen patients (76%) had one or more sacral meningeal cysts (MC) on MRI scan, whereas CT scan with myelography of the lumbar and sacral region revealed 7 patients (41%) with sacral MC. Sacral MC may be the etiology of chronic perineal pain in many instances, and MRI scan appears to be superior to CT scan with myelography in demonstrating sacral MC. Ten patients with sacral MC were operated on with moderate to excellent results 6 months after operation. Early postoperative results are encouraging, but further follow-up and larger series are required.