shukoor65/lab-rag-model huggingface dataset:
Evaluation of dipyridamole-Doppler echocardiography for detection of myocardial ischemia and coronary artery disease. Doppler assessment of left ventricular filling and ejection during dipyridamole stress may supplement wall motion analysis for detection of myocardial ischemia and coronary artery disease (CAD). Thirty-four patients taking no cardioactive therapy were studied using intravenous dipyridamole (0.6 mg/kg) during 2-dimensional and pulsed Doppler echocardiography. Twelve patients had normal coronary arteries (group 1) and the remainder, who had significant CAD, were divided into groups 2 (n = 11) and 3 (n = 11). Only subjects in group 2 developed myocardial ischemia manifest as reversible regional asynergy and ST-segment depression. Heart rate increased (16 +/- 9 beats/min, p less than 0.01) and mean blood pressure decreased (-5 +/- 8 mm Hg, p = not significant) uniformly across groups. Exaggerated hyperkinesia of normally contracting wall segments was the common response to dipyridamole infusion in patients with CAD. The respective mean percent changes in peak early diastolic velocity, peak atrial velocity, their ratio and ejection peak velocity, and mean acceleration for groups 1 (20, 42, -13, 20 and 23%), 2 (22, 32, -2, 10 and 14%) and 3 (23, 33, -6, 16 and 18%) were similar. Comparisons between normal patients and those with CAD and between groups 2 and 3 revealed no significant differences in the effect of dipyridamole on any variable. However, a decrease in both peak velocity and mean acceleration of left ventricular ejection was seen in 3 of 4 group 2 patients who developed severe ischemia. Dipyridamole-Doppler echocardiography is insensitive for detection of CAD and appears unable to identify myocardial ischemia unless this is severe. Hemodynamic changes and compensatory wall motion induced by dipyridamole may explain these findings.
Bile duct diverticula and webs: nonspecific cholangiographic features of primary sclerosing cholangitis. Biliary tree diverticula and webs are considered by several authors to be specific cholangiographic features of primary sclerosing cholangitis (PSC). Our experience suggested that these findings can be seen in patients without PSC. The purpose of this study was twofold: to establish whether diverticula and webs are indeed specific for PSC and to assess whether PSC can be accurately diagnosed without reference to diverticula or webs. We retrospectively reviewed 861 consecutive ERCP studies and found 32 cases of webs and/or diverticula. Using accepted cholangiographic, clinical, and histologic criteria, we diagnosed PSC in nine patients and excluded it in 21, with two instances of uncertain diagnoses. Webs and diverticula seen in PSC were cholangiographically indistinguishable from those in the group without PSC. All 21 patients without PSC had other biliary abnormalities, and were grouped by the predominant abnormality or finding believed to be associated with diverticulum or web formation: common duct stones or cholangitis (n = 11 patients), postoperative stricture (n = 4), bile duct stent and balloon dilatation (n = 3), malignant stricture (n = 2), and choledochoduodenostomy (n = 1). To assess cholangiographic diagnosis of PSC in these patients, a blinded reviewer studied the radiographs of the 30 patients with diverticula and/or webs who had confirmed diagnoses. By using established radiologic criteria alone (ignoring diverticula and webs), the correct diagnosis was made in 27, yielding a sensitivity of 89% and specificity of 91%. We conclude that the presence of diverticula and/or webs on a cholangiogram is a nonspecific finding and may be due to inflammation or trauma to the bile duct wall. Further, PSC can be distinguished from other abnormalities on the basis of findings other than diverticula and webs.
Liesegang rings developing within intraperitoneal endometriotic implants. A case report. Liesegang rings are acellular, laminated structures that have been reported to accompany a variety of necrotizing and hemorrhagic tissue processes. Although most frequently seen in the kidneys and synovium, they can be present in other tissues. Liesegang rings are of importance because they are frequently confused by pathologists with helminth ova and nematodes, which they resemble. A case of Liesegang rings was associated with intraperitoneal endometriotic implants, with which the rings appeared to have originated.
Autosomal recessive lethal infantile cytochrome C oxidase deficiency. Three bedouin children with mitochondrial myopathy due to cytochrome c oxidase deficiency presented with progressive muscle weakness, failure to thrive, proximal renal tubular acidosis, and lactic acidemia leading to death. Two died by age 5 months and one by age 16 months. Cytochrome c oxidase was markedly reduced in skeletal muscle extracts of all three. Three other children of the same family with most probably the same metabolic aberration are also described. We suggest an autosomal recessive inheritance for this lethal mitochondrial myopathy.
Rapid development of vitamin K deficiency in an adolescent boy receiving total parenteral nutrition following bone marrow transplantation. In this case report the development of a vitamin K deficiency in a neutropenic adolescent receiving parenteral nutrition following bone marrow transplantation is described. The parenteral nutrition solution did not provide vitamin K and the patient had been receiving oral antibiotics prior to and during use of the intravenous feeding. Oral intake was minimal. Standard adult oral and intravenous multivitamin preparations for use in individuals older than 11 years do not routinely contain this vitamin. The function of vitamin K and causes for development of a deficiency are reviewed. Recommended intakes and guidelines for supplementation are also discussed.
Risk factors for type-1 reactions in borderline leprosy patients. Type-1 or reversal reactions are the major cause of nerve damage and disability in leprosy. We wished to determine whether there were any clinical or laboratory markers that identified patients with an increased risk of type-1 reaction. 42 (31%) of 136 Nepalese borderline leprosy patients (97 male, 39 female; age range 7-73 years) had a type-1 reaction during the first 2 years of multi-drug therapy. Before therapy, 41 (98%) of the 42 patients were seropositive for antibodies to one of three mycobacterial antigens. Seropositivity for IgM antiphenolic-glycolipid-1 (PGL-1) antibodies, but not IgG anti-lipoarabinomannan or anti-Mycobacterium leprae 35 kDa protein antibodies, was significantly associated with subsequent manifestation of a type-1 reaction (p less than 0.001). The concentration of IgM anti-PGL-1 antibodies in serum was significantly higher in patients in whom a type-1 reaction developed. The risk attributable to anti-PGL-1 seropositivity was independent of leprosy class, skin smear positivity, and the presence of other anti-M leprae antibodies (adjusted odds ratio = 8.7, p less than 0.001). In the 87 patients who had a lepromin test, anti-PGL-1 seropositivity and lepromin reactivity were significant independent risk factors for subsequent reaction. 78% of patients with positive lepromin reactivity and IgM anti-PGL-1 antibodies had type-1 reactions. Patients with these risk factors should be carefully monitored during antimicrobial therapy to permit early initiation of anti-inflammatory treatment thus minimising permanent nerve damage and resultant disability.
Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis. The two main causes of gastrointestinal bleeding in cirrhosis are oesophageal varices and portal hypertensive gastropathy (PHG). Rebleeding from varices can be prevented by beta-blockers, but it is not clear whether these drugs effectively reduce rebleeding from PHG. 54 cirrhotic patients with acute or chronic bleeding from severe PHG took part in a randomised, controlled trial to investigate the efficacy of propranolol in prevention of rebleeding from PHG. 26 patients were randomised to receive propranolol daily at a dose that reduced the resting heart rate by 25% or to 55 bpm (20-160 mg twice daily), throughout mean follow-up of 21 (SD 11) months. 28 untreated controls were followed-up, with the same examinations, for 18 (13) months. The actuarial percentages of patients free of rebleeding from PHG were significantly higher in the propranolol-treated patients than in the untreated controls at 12 months (65% vs 38%; p less than 0.05) and at 30 months of follow-up (52% vs 7%; p less than 0.05). Propranolol-treated patients had fewer episodes of acute bleeding than controls (0.010 [0.004] vs 0.120 [0.040] per patient per month). Multivariate analysis showed that absence of propranolol treatment was the only predictive variable for rebleeding. Actuarial survival was slightly higher in the propranolol group than in the controls, but the difference was not significant. Thus, long-term propranolol treatment significantly reduces the frequency of rebleeding from severe PHG, and may improve the prognosis of cirrhotic patients with this disorder.
Rice solution and World Health Organization solution by gastric infusion for high stool output diarrhea. We sought to determine the efficacy of three different types of treatment in children with acute diarrhea who, during the oral rehydration period, had high stool output (greater than 10 mL/kg per hour). Sixty-six children, aged 1 to 18 months, with an average stool output of 22.6 mL/kg per hour were randomly distributed into three groups: group 1 received a rice flour solution, group 2 received the World Health Organization rehydration solution by gastric infusion, and group 3 continued to receive this solution orally. In all three groups, a decrease in stool output was observed, with the higher decrease observed in group 1 patients. Such a decrease facilitated rehydration of all 22 patients in group 1 (100%) in 3.3 +/- 1.5 hours, 16 (73%) in group 2 in 4.3 +/- 2.1 hours, and 15 (69%) in group 3 in 4.9 +/- 2.0 hours. No complications were observed. These data indicate that the rice flour solution is effective in children with high stool output diarrhea.
New technique of esophageal exclusion for chronic esophageal perforation. A new technique of near-total esophageal exclusion was used successfully in the treatment of 2 patients with chronic thoracic esophageal perforation and continuing sepsis. The most striking point of this technique is the use of cervical T-tube esophagostomy with the lower arm of the T tube circumfixed by chromic catgut tie to prevent swallowing of saliva. Whereas most of the previously reported procedures of cervical esophageal diversion require subsequent esophageal reconstruction, this technique is simple and effective and does not require a second operation.
Chronic pain: a PET study of the central effects of percutaneous high cervical cordotomy. We have studied 5 patients with unilateral, severe chronic pain due to cancer before and after percutaneous, ventrolateral cervical cordotomy to investigate the central effects of the procedure. The aim was to identify the functional anatomical correlates of abolishing unilateral nociceptive input to the brain. Patients were investigated by positron emission tomography using C15O2 to evaluate cerebral blood flow. Comparisons were made between the patients with unilateral pain before cordotomy and normal volunteers. These demonstrated significantly less blood flow in 3 out of 4 of the individual quadrants of the hemithalamus contralateral to the side of pain (P less than 0.01-0.05). These differences were abolished by cordotomy. Comparison of the patients before and after cordotomy showed a significant decrease in blood flow in the dorsal anterior quadrant of the thalamus contralateral to the side of pain (P less than 0.05) which was normalised after cordotomy. There were no significant changes in the prefrontal or primary somatosensory cortex. We conclude that chronic pain results in a decrease of synaptic activity at thalamic level either from decreased activity in neurones projecting to that region and/or attenuated local neuronal firing. We have demonstrated no secondary remote effects in cortex, indicating the importance of subcortical mechanisms in central responses to chronic pain.
Conservative management of breast fibroadenomas. Is it conservative or radical management to excise all fibroadenomas of the breast, especially in women less than 30 years old? Once a definite diagnosis is established by physical examination, fine-needle aspiration cytologic testing, and mammography, is it prudent to monitor women with small fibroadenomas (less than 4 cm in diameter)? We reviewed 498 cases of biopsy-proved fibroadenomas and 17 cases of phyllodes tumors (by biopsy) seen at Los Angeles County/University of Southern California Medical Center from 1986 to 1989. Analysis of patient age and measured tumor size in 203 fibroadenomas and 10 phyllodes tumor specimens revealed similar ranges for both tumors. The mean values were 28.5 years and 2.3 cm for fibroadenomas and 44 years and 3.8 cm for phyllodes tumors. No cases of coincident carcinoma within a fibroadenoma or of metastatic malignant phyllodes tumors were present in this review. As an alternative to excising all breast tumors, cytologically diagnosed fibroadenomas can be monitored, because they have no intrinsic premalignant potential and tend to regress with time. All breast tumors that rapidly increase in size should probably be excised at any age.
Total parenteral nutrition increases mortality after hemorrhage OBJECTIVES: To determine the effect of total parenteral nutrition (TPN) and different enteral feeding formulas on survival and liver function following hemorrhage in rats. DESIGN: Prospective randomized controlled study. SETTING: Laboratory of a large university-affiliated medical school. SUBJECTS: Sixty-seven male Sprague-Dawley rats weighing 350 to 450 g. INTERVENTIONS: Jugular and gastroduodenal feeding catheters were inserted in animals 1 day before hemorrhage, and animals were started on one of six different fluid or nutritional regimens: TPN, iv saline, an enteral amino acid-based formula (AA) (Vivonex-TEN), an enteral peptide-based formula (PEP) (Reabilan-HN), an enteral intact-protein based formula (PRO) (Osmolite-HN), or enteral saline. A catheter was inserted in the tail artery and animals were hemorrhaged 5 mL/kg at baseline and 1 hr later. Animals were returned to their cages and observed for survival. Liver function was determined by measuring circulating bile acid levels at baseline and 24 hr after hemorrhage. MEASUREMENTS AND MAIN RESULTS: Mortality was significantly increased in animals receiving TPN (63%) and AA (24%). Mortality was 13% in animals receiving PRO and 0% in animals receiving PEP and saline. Liver function deteriorated in all animals after hemorrhage except the PEP group. CONCLUSIONS: TPN and AA increased mortality in animals after hemorrhage. PEP was associated with zero mortality and protection of liver function after hemorrhage.
Comparative trial of cefprozil vs. amoxicillin clavulanate potassium in the treatment of children with acute otitis media with effusion. A total of 137 children with acute otitis media with effusion were randomly allocated to treatment with cefprozil (30 mg/kg/day divided into two equal doses), an investigational cephalosporin or amoxicillin clavulanate potassium (40 mg/kg/day divided into three equal doses) for 10 days. The most common pathogens obtained from middle ear cavities by tympanocentesis were Streptococcus pneumoniae (33%), Haemophilus influenzae (19.6%) and Moraxella catarrhalis (8.3%). Patients were scheduled for follow-up visits at midtreatment, at end of therapy and at 30 days. Of the 137 children 122 were evaluable. Five of 60 patients (8.3%) treated with cefprozil and 14 of 62 patients (22.5%) treated with amoxicillin clavulanate potassium were considered therapeutic failures because of persistence of symptoms and/or isolation of the original pathogen or superinfection (P = 0.05). Rates of relapse, reinfection and persistent middle ear effusion as documented by tympanogram were comparable in both groups. When persistent middle ear effusion was analyzed by pneumatic otoscopy, 64 of 103 affected ears (62.1%) treated with cefprozil and 80 of 105 affected ears (76.1%) treated with amoxicillin clavulanate potassium were abnormal (P = 0.04). Loose stools were more common in children treated with amoxicillin clavulanate potassium than in children treated with cefprozil (P = 0.0004). Based on the efficacy results from this study, the lower gastrointestinal side effects and the convenience of twice-a-day dosing, we believe that cefprozil in a dosage of 30 mg/kg/day divided every 12 hours represents a potential alternative for the treatment of acute otitis media with effusion in children.
Are malignant melanoma patients at higher risk for a second cancer? This study tests whether malignant melanoma (MM) patients are at higher risk of having an unrelated second cancer by comparing the observed incidence of a second cancer in a given population of MM patients with the expected number in an age-matched and sex-matched group of healthy people followed for a similar period. The analysis was based on the person-years method in which the main consideration is the follow-up period after the diagnosis of MM. Of 370 patients with histologically confirmed MM, 27 (7.3%) had a second noncutaneous invasive cancer, diagnosed either simultaneously (within 6 months, five patients) or after the diagnosis of MM (22 patients). The follow-up period for the entire MM group was 1253 person-years, a period during which the expected number of cancer cases in the normal population, according to the Israel Cancer Registry, was 6.6. The observed-expected ratio or the relative risk (RR) was 4.1 (P less than 0.01). After excluding the five patients with simultaneous diagnosis of MM and a second cancer, analysis of the remaining 22 patients in whom MM definitely preceded the second cancer showed an RR of 3.3 (P less than 0.01). For the entire group, there were nine patients with breast cancer, five with head and neck cancer (two with thyroid and three with oral cavity cancer), five with gynecologic cancer (one with uterine and four with ovarian cancer), five myeloproliferative malignancies (one with lymphoma, three with chronic lymphocytic leukemia, and one with myeloma), three gastrointestinal carcinomas (two with colon and one with stomach cancer), and two soft tissue sarcomas. When the differential analysis according to gender and age was done, it was found that the RR was higher for women (5.5, P less than 0.01) than for men where the RR was 2.2 (P less than 0.05). Differential analysis for various age groups showed that the trend for second cancer was consistent in all age groups, with a slight increase in the younger ones. None of the variables of MM, such as location of the primary tumor, level of invasion, or stage, were predictive for a second cancer. Furthermore, the RR for a second cancer did not relate significantly with the treatment given to the MM patient. Concerning the type of second cancer, it was found that the RR was especially high for breast cancer--6.6. These data indicate that MM patients may be at higher risk for having a noncutaneous invasive cancer compared with the general population.
Sezary syndrome in a patient with hairy cell leukemia in remission. A 65-year-old man was evaluated for pancytopenia in March 1979, and found to have hairy cell leukemia (HCL). Treatment with splenectomy and subsequently interferon produced temporary remissions. In July 1985, the patient began intravenous deoxycoformycin (DCF) therapy, and after 1 year complete peripheral blood and bone marrow remission was achieved. Fourteen months after cessation of therapy, the patient developed a skin rash and was found to have cutaneous T-cell lymphoma and Sezary syndrome. Morphologic study of the hairy cells (HC) in the peripheral blood at presentation and the Sezary cells was distinct by light and electron microscopic study. Immunophenotyping of peripheral blood mononuclear cells showed clearly that the HC were of B-cell origin (CD20+, sIg+), whereas the lymphoid population at second presentation was T-cell (CD3+, CD4+, HLA-DR-). Clonal rearrangement of T-cell antigen receptor beta-chain gene was detected by Southern analysis of the Sezary cell population, whereas immunoglobulin heavy and light chain genes remained in germ line configuration. This is the first case of Sezary syndrome developing in a patient previously treated for HCL where studies have confirmed distinct B-cell and T-cell origin of the two neoplasms. The authors suggest that treatment and disease-related immunosuppression are possible etiologic factors in the development of this second lymphoid neoplasm.
Fractures of the spine in diffuse idiopathic skeletal hyperostosis. Fractures of the spine in diffuse idiopathic skeletal hyperostosis (DISH) have rarely been reported. Only four cases could be found in the world literature. Eight new cases with nine fractures are reported in this study. The critical features are the frequent delays in diagnosis (three of eight patients) and the high rate of immediate and delayed neurologic deficit (seven of eight patients). Two fracture patterns occurred in this group. The first type occurred through the midportion of an ankylosed segment of the spine and involved the vertebral body (five fractures). The second type occurred at the top or bottom of a fused segment (four fractures). The latter were disk disruptions or odontoid fractures. This is a marked difference from spinal fractures in ankylosing spondylitis, in which the majority are transdiskal fractures. The difference can be explained on the basis of the different pathology of these two disease processes. Careful evaluation of patients with DISH who sustain trauma is critical. Treatment of this rare injury should be early stabilization of the spine to avoid complications of nonunion, deformity, neurologic injury, and death.
Right ventricular infarction: recognition and assessment of its hemodynamic significance by two-dimensional echocardiography. To evaluate the ability of two-dimensional echocardiographic indexes to determine the hemodynamic significance of the right ventricular infarction, 24 patients with electrocardiographic evidence of right ventricular infarction were studied. Hemodynamic significance was defined as a jugular venous pressure greater than 17 cm H2O or a right atrial pressure greater than 13 mm Hg. Patients with hemodynamically significant right ventricular infarctions (group I, n = 9) had a 56% incidence of hypotension (blood pressure less than 90 mm Hg) with a mean systolic blood pressure of 93 +/- 23 mm Hg, whereas patients with nonhemodynamically significant right ventricular infarctions (group II, n = 15) had no hypotension and a mean systolic blood pressure of 121 +/- 18 mm Hg (p less than 0.01). The ratio of right atrial to pulmonary capillary wedge pressure was 1.1 +/- 0.6 in group I and 0.6 +/- 0.2 in group II (p less than 0.05). Echocardiography demonstrated right ventricular free wall motion abnormalities in seven patients in group I and in 10 patients in group II. The descent of the right ventricular base was 0.7 +/- 0.2 cm in group I, 1.3 +/- 0.4 cm in group II, and 2.0 +/- 0.2 cm in a group of 20 normal control patients (p less than 0.001 for all comparisons). The respiratory caval index (percentage of collapse of the inferior vena cava with inspiration) was 22% +/- 11% in group I, 45% +/- 15% in group II, and 64% +/- 17% in the control subjects (p less than 0.05 for all comparisons).