shukoor65/lab-rag-model huggingface dataset:
Slipped capital femoral epiphysis. A quantitative analysis of motion, gait, and femoral remodeling after in situ fixation. A prospective clinical study was done for quantitative examination of motion of the hip, gait, and proximal femoral remodeling after in situ fixation of a slipped capital femoral epiphysis. In situ fixation was performed in forty-five consecutively treated patients (fifty-six hips). Thirty-nine (87 per cent) of the patients returned for examination two years after treatment. The greatest percentage of motion of the hip returned within six months after treatment. Despite loss of internal rotation of the hip, the mean foot-progression angle was 10.8 degrees. Radiography and computerized tomographic scanning revealed minimum change in the relationship of the femoral head to the femoral shaft and no change in the neck-shaft angle. Motion returned despite minimum osseous remodeling. The early return of motion (in the first three months) may have been due to relief of pain, spasm, and synovitis, while soft-tissue stretching and resorption of bone in the anterolateral part of the femoral neck may have accounted for the remainder of the increase in internal rotation.
Dissection of the protein kinase cascade by which nerve growth factor activates MAP kinases. Mitogen activated protein (MAP) kinases (MAPKs) are a family of protein-serine/threonine kinases activated as an early intracellular response to a variety of hormones and growth factors. They are unique in requiring both serine/threonine and tyrosine phosphorylation to become active and are the only examples of protein-serine/threonine kinases activated by tyrosine phosphorylation. Nerve growth factor (NGF) promotes differentiation of phaeochromocytoma (PC12) cells, which respond by conversion within hours from a chromaffin-like to a sympathetic neuron-like phenotype. NGF stimulation of PC12 cells increases the activity of two protein kinases by greater than 20-fold within minutes, both strikingly similar to MAPKs. They are inactivated by either protein-tyrosine phosphatases or the protein-serine/threonine phosphatase termed protein phosphatase 2A (ref. 8), they activate protein S6 kinase-II (refs 9, 10), and they phosphorylate identical threonine residues on myelin basic protein (our unpublished results) to those phosphorylated by other MAPKs. Immunological data indicate that these protein kinases, termed peak-I and peak-II (Fig. 1a) are probably ERK2 and ERK1, respectively, two widely expressed MAPK isoforms. Here we identify the 'MAP kinase kinases' (MAPKKs) in PC12 cells which are activated by NGF and report that MAPKKs are dependent on serine/threonine phosphorylation for activity and promote phosphorylation of serine/threonine and tyrosine residues on MAPKs.
Assessment of a daily combined preparation of isoniazid, rifampin, and pyrazinamide in a controlled trial of three 6-month regimens for smear-positive pulmonary tuberculosis. Singapore Tuberculosis Service/British Medical Research Council In a study in Singapore 310 patients with sputum smear-positive pulmonary tuberculosis were allocated at random to daily chemotherapy with streptomycin, isoniazid, rifampin, and pyrazinamide (1) for 2 months (2SHRZ), (2) for 1 month (1SHRZ), or (3) for 2 months without streptomycin (2HRZ). This was followed for all patients by three times weekly isoniazid and rifampin to a total duration of 6 months. During the initial period of daily chemotherapy the patients were also allocated at random to be given their HRZ either as a combined formulation (Rifater), each tablet containing 50 mg isoniazid, 120 mg rifampin, and 300 mg pyrazinamide, or as three separate drugs. During the Rifater versus separate drugs comparison the most common spontaneous complaints were of nausea and vomiting, reported by 8% of 155 patients receiving Rifater and 7% of 155 separate drugs. Other adverse effects were also reported in similar proportions in the two series. Among 271 patients with drug-susceptible strains of tubercle bacilli pretreatment there were no bacteriologic failures during chemotherapy. During 18 months of subsequent follow-up bacteriologic relapse occurred in 3 (7%) of 46 2SHRZ, 2 (5%) of 42 1SHRZ, and 3 (8%) of 40 2HRZ patients allocated to Rifater and in 0 of 47 2SHRZ, 1 (2%) of 46 1SHRZ, and 1 (2%) of 44 2HRZ patients allocated to separate drugs. There was no evidence of therapeutic benefit from continuing SHRZ administration beyond 1 month or from adding streptomycin to HRZ. The relapse rates were slightly higher in the Rifater series (p = 0.04). Further follow-up and results from other studies are therefore needed fully to assess the combined preparation.
Heart rate response during exercise testing and ambulatory ECG monitoring in patients with syndrome X. The response of the heart rate during exercise testing and 24-hour ambulatory electrocardiographic (ECG) monitoring performed with patients not receiving antianginal treatment was assessed in 26 patients (9 men and 17 women; mean age 51 +/- 8 years) with syndrome X (angina pectoris with normal coronary arteries), in 27 patients with coronary artery disease (10 men and 17 women; mean age 55 +/- 9 years), and in 21 healthy subjects (8 men and 13 women; mean age 47 +/- 11 years). In patients with syndrome X the slope of the regression line of heart rate versus time (heart rate/time slope) during exercise testing was similar to that of patients with coronary artery disease (3.3 +/- 0.8 versus 3.1 +/- 1.2 beats/min), but significantly lower than that in healthy subjects (4.2 +/- 1.1 beats/min; p less than 0.003). In patients with syndrome X the intercept of the heart rate/time slope was significantly higher than that in coronary artery disease patients and healthy subjects (102 +/- 15, 86 +/- 18, and 90 +/- 16 beats/min, respectively; p less than 0.015). Resting preexercise heart rate was also significantly higher in syndrome X, compared with coronary artery disease patients and healthy subjects (91 +/- 16, 79 +/- 16, and 80 +/- 14 beats/min, respectively). During ambulatory ECG monitoring, mean diurnal heart rate (from 6 AM to 6 PM) was higher in patients with syndrome X (83 +/- 8 beats/min) than in patients with coronary artery disease (75 +/- 8 beats/min) and healthy subjects (74 +/- 11 beats/min) (p less than 0.02).
Human immunodeficiency virus infection among homeless men in a New York City shelter. Association with Mycobacterium tuberculosis infection. The human immunodeficiency virus (HIV) seroprevalence among a selected sample of 169 high-risk homeless men residing in a congregate shelter in New York City, NY, was 62%. Seropositivity for HIV correlated significantly with intravenous drug use (odds ratio, 3.3; 95% confidence interval, 1.4 to 4.4) and active tuberculosis (odds ratio, 7.0; 95% confidence interval, 3.4 to 13.5). Most cases of active tuberculosis were among homeless men with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex; and significant CD4 lymphocyte depletion was associated with active tuberculosis. Total time homeless correlated positively with active and latent tuberculosis infection. Compliance rates with return for HIV antibody test results, medications, and follow-up visits were 70%, suggesting a significant degree of knowledge, awareness, and personal concern regarding HIV infection among homeless men; yet 28% of homeless intravenous drug users continue active drug injection, despite HIV infection. Cohabitation in overcrowded congregate dormitories creates a risk of airborne transmission of tuberculosis, which is a common reactivation infection in HIV-seropositive homeless men. Medically appropriate housing should be provided to such homeless persons, and expanded HIV antibody testing, counseling, and medical services on site should be offered to residents of shelters.
An eyelash nidus for dacryoliths of the lacrimal excretory and secretory systems. We treated two patients with dacryolithiasis secondary to an eyelash. The first patient underwent dacryocystorhinostomy for a stone within the lacrimal sac. In the second patient the dacryolith was removed from a lacrimal gland ductule. Eyelashes found in the tear film or conjunctival fornices during routine examination should be removed to prevent the possible occurrence of dacryolithiasis.
Catecholamine responses to histamine infusion in man. To evaluate the effects of histamine-induced hypotension on plasma catecholamine levels, eight normal men, aged 20 to 40 years, were infused with incremental doses of histamine starting at 0.2 microgram/kg/min at a 30 degree tilt position with monitoring of blood pressure (BP) and heart rate. Histamine dosage was increased every 5 minutes by 0.1 to 0.2 microgram/kg/min until mean BP fell greater than 15 mm Hg or a dosage of 1.6 micrograms/kg/min was reached. Plasma catecholamine samples were taken between the fourth and fifth minute of each histamine dosage. Identical measurements were made during nitroglycerin-induced hypotension in these subjects. Histamine produced threefold greater increases in heart rate and plasma norepinephrine (NE) levels than did nitroglycerin for comparable decreases in BP. Although NE levels increased twofold to fivefold from baseline with histamine infusion, epinephrine levels increased minimally at the highest doses or not at all. Our data demonstrate that histamine selectively releases NE from adrenergic nerve terminals without significant adrenal catecholamine release. We suggest that neural NE release plays an important role in the cardiac effects of histamine.
Radiotherapy of advanced laryngeal cancer using three small fractions daily. Since 1983, we have treated advanced (UICC stages III and IV) squamous carcinomas of the larynx by primary radiotherapy, using three small fractions a day, 3-4 h interfraction interval, 5 days per week. The early patients received doses per fraction of 1.5 Gy, and a total dose of approximately 70 Gy, given as a split-course over 6 to 7 weeks. While overall tumor control and laryngeal preservation was good, a number of severe late radiation reactions were seen. The schedule was then modified, with a reduction in the fraction size to 1.1 Gy, the total dose to 60 Gy, and the overall time to 4 weeks, with omission of the mid-treatment "split." Since 1986, we have treated 26 patients in this way. Acute reactions are brisk, but rapidly healing. Loco-regional control was achieved in 22 patients, only one of whom has relapsed to date, in a solitary node, salvaged by radical neck dissection. Four have died of uncontrolled loco-regional malignancy, and three of intercurrent disease while in clinical remission. No serious late morbidity has been observed in surviving patients, and vocal quality is good in the majority. These results suggest that this hyperfractionated and accelerated radiotherapy schedule may offer an acceptable nonsurgical, voice-preserving treatment for advanced laryngeal carcinoma; it can be used in a normally working radiotherapy department.
Double-blind randomized multicenter study comparing Maalox TC tablets and ranitidine in healing of duodenal ulcers. The efficacy of ranitidine 150 mg twice daily and Maalox TC three tablets four times daily were compared in patients with endoscopically confirmed duodenal ulcer. Seventy-nine patients were randomly allocated to double-blind, double-dummy treatment, stratified for smokers. Endoscopy was repeated after four weeks. Those unhealed continued treatment for a further two weeks before final endoscopy. Per protocol analysis in 53 patients showed ulcer healing rates at week 4 and at weeks 4 and 6 combined of 78 and 89% on Maalox TC, and of 81 and 91% on ranitidine, respectively. The same analysis gave overall healing rates of 81% in smokers and 100% in nonsmokers, irrespective of treatment. Both treatments provided early ulcer pain relief. Diarrhea was a commoner side effect in patients on Maalox TC. The study showed Maalox TC and ranitidine were equally effective in healing duodenal ulceration.
Multicenter trial of prophylaxis with clindamycin plus aztreonam or cefotaxime in gynecologic surgery. A prospective, randomized, multicenter study was conducted on the efficacy and safety of two prophylactic antibiotic regimens in both abdominal and vaginal hysterectomy. Patients received three intravenous doses of clindamycin (900 mg) plus either aztreonam (1 g) or cefotaxime (1 g); the doses were given at the induction of anesthesia and 8 and 16 hours later. A total of 170 patients undergoing abdominal hysterectomy and 142 patients undergoing vaginal hysterectomy completed the trial and were evaluated. Following abdominal hysterectomy infections occurred at the operative site in 1.2% of patients given a regimen including aztreonam and in 4.7% of those given a regimen including cefotaxime; the difference between the two groups was not significant. Neither were significant differences observed in the incidence of fever, the incidence of bacteriuria, the need for postoperative antibiotics, or the duration of postoperative hospitalization, although results were slightly better for patients receiving clindamycin plus aztreonam. Following vaginal hysterectomy, slightly but not significantly better results for the same parameters were obtained in the group given clindamycin plus cefotaxime. Diarrhea was the only adverse reaction attributable to antibiotic treatment and occurred more frequently in patients given cefotaxime. It was concluded that the two regimens were similarly effective and safe in preventing infections following hysterectomy.
Post-sclerotherapy bacterial peritonitis. Endoscopic variceal sclerotherapy has been associated with a number of complications. Peritonitis after sclerotherapy has rarely been reported. In this retrospective review of 213 consecutive sclerotherapy procedures among 65 patients over a 3-yr period, we found that six cases of peritonitis occurred, for an incidence of approximately 3%. All patients developing post-sclerotherapy peritonitis had low ascitic fluid protein. However, this did not differ from patients who did not develop peritonitis. No patient on antibiotics at the time of sclerotherapy developed peritonitis. Peritonitis should be considered in the diagnosis of post-sclerotherapy fever. The role of prophylactic antibiotics to prevent this complication is uncertain.
Renal atrophy or infarction in children with neuroblastoma. Twelve children with adrenal or upper abdominal paraaortic neuroblastoma developed unilateral or bilateral renal atrophy or infarction. At presentation, the children ranged in age from 2 weeks to 9.7 years. Neuroblastomas were stage II (n = 1), III (n = 2), IV-S (n = 2), and IV (n = 7). Treatment varied but included surgery, chemotherapy, localized abdominal irradiation, and/or bone marrow transplantation. Six children developed ipsilateral renal atrophy, five experienced ipsilateral or bilateral acute perioperative renal infarction, and one developed contralateral renal infarction unrelated to surgery. During treatment, two patients required hemodialysis; both subsequently died. Creatinine concentrations in eight patients have been in the normal range. Two patients have had mildly but persistently elevated creatinine levels. Renal damage from primary effects of the tumor can develop in children with adrenal or upper abdominal neuroblastoma. Treatment, especially surgical resection of the primary tumor, chemotherapy, and radiation therapy, can compound such damage.
Prognostic factors in childhood acute encephalitis. We have studied the prognostic factors in 462 children, from 1 month to 16 years old, with acute encephalitis. Death occurred in 2.8% patients, 6.7% were severely damaged and 90.5% were cured with no or only minor sequelae. The risk of death or severe damage in patients less than 1 year of age was 5.0-fold (95% confidence limits, 2.2 to 11.6; P less than 0.001) greater than that of older children. When compared with those children whose level of consciousness had been normal before admission, children who had been disoriented before admission had a 3.9-fold (1.1 to 14.3, P less than 0.05) risk and those who had been unconscious had a 25.4-fold (7.3 to 88.1, P less than 0.001) greater risk of death or severe damage. The risk of death or severe damage in patients with herpes simplex virus encephalitis was 11.7-fold (3.8 to 35.8, P less than 0.001) and in patients with Mycoplasma pneumoniae encephalitis it was 7.0-fold (2.6 to 18.7, P less than 0.001) that of other children. All patients with none of the above mentioned risk factors were cured without any major sequelae. We conclude that specific attention should be paid to the youngest patients, especially to those with an impaired level of consciousness, and all available measures should be focused on early detection of herpes simplex virus or M. pneumoniae infection.
Metastases of a gastric adenocarcinoma presenting as colonic polyposis. Report of a case. The authors report a case of multiple colonic metastases of a gastric signet ring cell adenocarcinoma, presenting as colonic polyposis revealed by diarrhea, iron deficiency anemia, and left supraclavicular lymph node.
The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Repetitive stimulation of small diameter primary afferent fibres produces a progressive increase in action potential discharge (windup) and a prolonged increase in the excitability of neurones in the spinal cord following the stimulus. Previous studies have demonstrated that windup is the consequence of the temporal summation of slow synaptic potentials and that the slow potentials and windup are reduced by pretreatment with N-methyl-D-aspartic acid (NMDA) antagonists. We have now examined whether primary afferent induced hypersensitivity states in flexor motoneurones are also dependent on the activation of NMDA receptors and whether windup is a possible trigger for the production of the central hypersensitivity. Both a non-competitive (MK-801) and a competitive (D-CPP) NMDA antagonist, at doses that did not modify the baseline reflex, reduced the facilitation of the flexor reflex produced by either brief electrical stimulation of the sural nerve (1 Hz for 20 sec at C-fibre strength), or by the cutaneous application of the chemical irritant mustard oil. These antagonists also prevented windup from occurring in the motoneurones. When the the MK-801 and the D-CPP were administered once a state of central facilitation had been induced by prior treatment with mustard oil, they returned the facilitated reflex to its pretreatment level. These results indicate that NMDA receptors are involved in the induction and maintenance of the central sensitization produced by high threshold primary afferent inputs. Because central sensitization is likely to contribute to the post-injury pain hypersensitivity states in man, these data have a bearing both on the potential role of NMDA antagonists for pre-emptive analgesia and for treating established pain states.
C terminus of the small GTP-binding protein smg p25A contains two geranylgeranylated cysteine residues and a methyl ester. smg p25A, also known as the rab3A protein, is a small GTP-binding protein that has been implicated in intracellular vesicle transport and the secretion of neurotransmitters. It has been shown to bind reversibly to membranes, though its cDNA-predicted sequence contains no obvious membrane-binding domains. However, smg p25A does contain a cDNA-predicted C-terminal Cys-Ala-Cys sequence at positions 218 through 220, which suggests that it may be posttranslationally modified. In the present study we used two different approaches to investigate this possibility. First, we incubated pheochromocytoma cells with [3H]mevalonolactone, examined the proteins that became labeled by two-dimensional gel electrophoresis, and demonstrated that two of these proteins exactly corresponded to smg p25A. Second, we purified smg p25A from bovine brain membranes and analyzed both the full-length protein and a proteolytically derived C-terminal peptide by a combination of high performance liquid chromatography and mass spectrometry. This approach revealed that the protein's C-terminal region is methyl-esterified and contains two geranylgeranyl groups linked via thioether bonds to Cys-218 and Cys-220. Since smg p25A is one of several small GTP-binding proteins that share a C-terminal Cys-Xaa-Cys consensus sequence (where Xaa is an unspecified amino acid), our results suggest that these proteins may be similarly geranylgeranylated and methyl-esterified.
Impact of diagnosis-related groups on the quality of postoperative care of patients with neck dissections. Two hundred eighty patients underwent neck dissection over a 10-year period: 138 during the 5-year period before the institution of Diagnosis-Related Group (DRG) reimbursement and 142 during the 5 years after DRG regulations. A comparison of these two groups by site of tumor, stage of disease, histopathology, previous treatment, type of neck dissection, whether neck dissection was carried out alone or in combination with another procedure, presence of preexisting disease, postoperative complications, and mortality revealed no significant differences. A 35% reduction in the length of hospital stay from 16 to 10 days was identified in the post-DRG group with no detrimental effects on patient care. The variables found to have the greatest impact on length of hospital stay were the extent of operation and postoperative complications.
Monomorphous histiocytoma in a child. Report of a case with ultrastructural features suggestive of dendritic cell differentiation. The authors describe a rapidly growing soft tissue tumor of predominantly histiocytic composition in an 8-year-old child. The tumor cells were identified as elements of the mononuclear phagocyte system by histologic, histochemical, immunologic, and electron microscopic study. Despite the presence of a minor fibroblastic component, the tumor did not conform to established criteria for a diagnosis of malignant fibrous histiocytoma. Formation of frequent desmosome-like intercellular junctions raised the possibility of dendritic reticulum cell differentiation, since the latter cells seem to be the only elements of the mononuclear phagocyte system that display such specialized cell junctions. The results of immunostaining were discrepant with those reported for normal dendritic reticulum cells, but the currently available information makes it doubtful that the entire neoplastic spectrum of dendritic cell differentiation can currently be diagnosed in surgical pathology.