shukoor65/lab-rag-model huggingface dataset:
Vitamin A levels in premenstrual syndrome. To determine whether changes in peripheral vitamin A levels are associated with symptoms of premenstrual syndrome (PMS), 10 PMS patients and 10 controls were studied. They gave blood at 2- or 3-day intervals through three menstrual cycles. The vitamin A was measured by fluorometry after cyclohexane extraction. In the controls, vitamin A values were 68.0 +/- 3.2 micrograms/dL (mean +/- SE) during the luteal phase and 69.8 +/- 4.2 micrograms/dL during the follicular phase. No significant changes were noted between the two values. In the patients, the values were 73.9 +/- 4.2 micrograms/dL during the luteal phase, which was not significantly different from 72.7 +/- 1.8 micrograms/dL during the follicular phase. No significant changes were noted between the controls and the patients in either the luteal or the follicular phase. Vitamin A deficiency in PMS patients was not demonstrated in our study.
Observations and current operative management of congenital lumbar hernias during infancy. Congenital hernias in the lumbar region are very uncommon. Approximately 10 per cent of all lumbar hernias are congenital and the vast majority are unilateral. We report our experience with seven congenital lumbar hernias in six infants treated during a five year period. All patients presented in the first year of life with abnormal protrusions in the lumbar region. In addition to the lumbar hernia, major associated malformations, including caudal regression anomalies, diaphragmatic hernia, ureteropelvic junction obstruction, cloacal exstrophy and lipomeningocele, were observed in 66 per cent of the infants and were consistent with lumbocostovertebral syndrome. In five patients, unilateral defects were repaired primarily. One patient with bilateral lumbar hernia underwent staged repair. The larger right-sided defect was repaired using a polytetrafluoroethylene prosthesis. At a second operation two months later, the small left-sided hernia was closed primarily. All patients have done well without recurrence with a follow-up period ranging from four to 48 months. Early repair of congenital lumbar hernias in infants after correction of other life-threatening conditions is advocated. Unlike the acquired variety, congenital lumbar hernia may include a more extensive deficiency of the entire lateral abdominal wall extending to the rectus sheath and inguinal ligament and satisfactory closure of the defect without prosthetic material may be difficult or impossible.
Left ventricular pressure-volume and Frank-Starling relations in endurance athletes. Implications for orthostatic tolerance and exercise performance. BACKGROUND. Endurance athletes have a high incidence of orthostatic intolerance. We hypothesized that this is related to an abnormally large decrease in left ventricular end-diastolic volume (LVEDV) and stroke volume (SV) for any given decrease in filling pressure. METHODS AND RESULTS. We measured pulmonary capillary wedge (PCW) pressure (Swan-Ganz catheter), LVEDV (two-dimensional echocardiography), and cardiac output (C2H2 rebreathing) during lower body negative pressure (LBNP, -15 and -30 mm Hg) and rapid saline infusion (15 and 30 ml/kg) in seven athletes and six controls (VO2max, 68 +/- 7 and 41 +/- 4 ml/kg/min). Orthostatic tolerance was determined by progressive LBNP to presyncope. Athletes had steeper slopes of their SV/PCW pressure curves than nonathletes (5.5 +/- 2.7 versus 2.7 +/- 1.5 ml/mm Hg, p less than 0.05). The slope of the steep, linear portion of this curve correlated significantly with the duration of LBNP tolerance (r = 0.58, p = 0.04). The athletes also had reduced chamber stiffness (increased chamber compliance) expressed as the slope (k) of the dP/dV versus P relation (chamber stiffness, k = 0.008 +/- 0.004 versus 0.031 +/- 0.004, p less than 0.005; chamber compliance, 1/k = 449.8 +/- 283.8 versus 35.3 +/- 4.3). This resulted in larger absolute and relative changes in end-diastolic volume over an equivalent range of filling pressures. CONCLUSIONS. Endurance athletes have greater ventricular diastolic chamber compliance and distensibility than nonathletes and thus operate on the steep portion of their Starling curve. This may be a mechanical, nonautonomic cause of orthostatic intolerance.
Organization and stability of a polytopic membrane protein: deletion analysis of the lactose permease of Escherichia coli. The overall topology of polytopic membrane proteins is thought to result from either the oriented insertion of the N-terminal alpha-helical domain followed by passive insertion of subsequent helices or from the function of independent topogenic determinants dispersed throughout the molecules. By using the lactose permease of Escherichia coli, a well-characterized membrane protein with 12 transmembrane domains and the N and C termini on the cytoplasmic surface of the membrane, we have studied the insertion and stability of in-frame deletion mutants. So long as the first N-terminal and the last four C-terminal putative alpha-helical domains are retained, stable polypeptides are inserted into the membrane, even when an odd number of helical domains is deleted. Moreover, even when an odd number of helices is deleted, the C terminus remains on the cytoplasmic surface of the membrane, as judged by lacY-phoA fusion analysis. In addition, permease molecules devoid of even or odd numbers of putative transmembrane helices retain a specific pathway for downhill lactose translocation. The findings imply that relatively short C-terminal domains of the permease contain topological information sufficient for insertion in the native orientation regardless of the orientation of the N terminus.
Use of the ultrathin choledochoscope in cholecystectomy. Use of the ultrathin choledochoscope (2mm) was evaluated in 80 patients undergoing routine cholecystectomy. It was used successfully in 67 (84 per cent) patients. There were eight (12 per cent) explorations of the common bile duct and no negative explorations. The instrument was helpful in determining the nature of an equivocal on-table cholangiogram. The ultrathin choledochoscope may be useful in reducing the rate of negative common bile duct exploration.
Induction of delayed hypersensitivity to human tumor cells with a human monoclonal anti-idiotypic antibody. There is considerable interest in the development of anti-idiotypic antibodies as vaccines in a number of diseases, including cancer. We have developed a human anti-idiotypic monoclonal antibody (105AD7) which binds at or very near to the binding site of mouse antitumor monoclonal antibody 791T/36. The 791T/36 antibody binds to a tumor-associated antigen (gp72) expressed on a number of human tumors, including colorectal and ovarian carcinomas and osteogenic sarcoma. This study shows that, in rats and mice, 105AD7 induces delayed-type hypersensitivity to human tumor cells bearing the gp72 antigen. Local transfer of delayed hypersensitivity was also demonstrated using lymphocytes from mice primed with 105AD7. These findings show that the human monoclonal anti-idiotypic antibody 105AD7 is likely to induce cellular immune responses to tumors in cancer patients.
Histamine concentration of gastric mucosa in Helicobacter pylori positive and negative children. The histamine concentration was determined by enzymatic isotopic method in biopsy specimens of oxyntic mucosa from 37 children. Nineteen of the 37 had Helicobacter pylori associated gastritis (9 with duodenal ulcer). The histamine concentration in the H pylori negative group was mean (SD) 54.1 (23.1) micrograms/g fresh weight, and that in the H pylori positive group was 26.3 (14.2) micrograms/g (p less than 0.01). There was also a significant difference between H pylori positive patients with duodenal ulcer (19.8 (6.3) micrograms/g) and those without ulcer (31.4 (17.9) micrograms/g) (p less than 0.05). These results suggest that H pylori positive patients, especially those with duodenal ulcer, have reduced 'stored' histamine, perhaps because of increased histamine liberation.
Intrathecal phenol rhizotomy for management of pain in recurrent unresectable carcinoma of the rectum. The medical records of 11 patients with recurrent unresectable adenocarcinoma of the rectum who had intrathecal phenol block for the management of intractable pain were reviewed. There were seven patients with pelvic and four with combined pelvic and perineal recurrences. Five patients had sacral involvement by tumor. Six patients had received prior irradiation. Three patients had good, three had fair and five patients had poor results after phenol rhizotomy. Patients with good results had relief for a median of three months. The over-all survival rate after phenol injection was three months. Phenol rhizotomy is indicated for the relief of intractable pain secondary to recurrent unresectable carcinoma of the rectum in carefully selected patients.
Photodynamic therapy of oncogene-transformed cells. Photodynamic therapy with dihematoporphyrin ether sensitizes malignant cells to damage by 630 nm light. The in vitro, in vivo photodynamic therapy sensitivity of a cell line transformed by the Kirsten ras oncogene (45342) was studied to establish a new photodynamic therapy model. With the colony formation assay, neither light alone nor dihematoporphyrin ether alone affected 45342 survival. Energy-dependent photodynamic therapy effects were seen in vitro in dihematoporphyrin ether-incubated and light-exposed cells (90% cytotoxicity = 950 joules/m2; 99% cytotoxicity = 1575 joules/m2; p2 less than 0.05). Subcutaneous allografts of 45342 were established in nu/nu mice, and ideal route (intravenous or intraperitoneal) of dihematoporphyrin ether delivery, dihematoporphyrin ether tissue kinetics, and in vivo photodynamic therapy effects were examined. Intravenous administration not only gave higher levels of the sensitizer in various tissues, but also was associated with less variation than the intraperitoneal route. Selective dihematoporphyrin ether retention was documented in the tumors at 24 hours after injection compared with other tissues, and photodynamic therapy with 0.3 W/cm2 to a total dose of 150 joules/cm2 led to progressive coagulative tumor necrosis and tumor regression. These studies confirm that transformed, malignant cells are sensitive to photodynamic therapy, and this model may prove in future studies to increase efficacy to photodynamic therapy (i.e., with dihematoporphyrin ether delivery by monoclonal antibodies).
Habitual leisure-time physical activity is associated with differences in various risk factors for coronary artery disease. Various risk factors for coronary artery disease (CAD) were compared in 100 healthy, male factory workers, divided into two groups of 50 each on the basis of their leisure-time activity. The two groups, designated as sedentary and physically active, were similar in terms of age and body mass index, but the physically active group had a significantly slower pulse rate. In addition, the plasma glucose and insulin responses to an oral glucose load were significantly lower in physically active individuals. Furthermore, fasting plasma triglyceride concentration was significantly lower and the high-density lipoprotein-cholesterol concentration was higher in the physically active individuals. Thus, substantial benefits in terms of CAD risk were associated with increased leisure-time physical activity.
Echocardiographic assessment of atherosclerotic coronary lesions. Echocardiographic techniques to visualize normal and atherosclerotic coronary arteries include transthoracic, transesophageal, epicardial (intraoperative), and intravascular approaches. All are capable of visualizing portions of the coronary arteries, especially proximal, and demonstrating atherosclerotic lesions. However, none of these methods are able, at present, to completely examine the coronary tree, and therefore none are ready to be used as a standard clinical technique for the diagnosis and management of coronary artery disease. Technological advances will enhance the future clinical value and applicability of these techniques.
Costs and health consequences of cholesterol screening for asymptomatic older Americans. To predict the consequences of cholesterol screening among elderly Americans who do not have symptoms of heart disease, we explore the cost implications of a cholesterol screening program, evaluate evidence linking hypercholesterolemia to coronary heart disease and mortality in the elderly, and describe the likely effects of therapy of hypercholesterolemia. According to our calculations, if all Americans 65 years of age and older adhered to a cholesterol screening program similar to the one proposed by the National Cholesterol Education Program, minimum annual expenditures for screening and treatment would be between $1.6 billion and $16.8 billion, depending on the effectiveness of diet and the cost of the medications used to treat hypercholesterolemia. There is no direct evidence that this program would lessen overall morbidity or extend the lives of elderly Americans.
St. Thomas' Hospital cardioplegic solution. Beneficial effect of glucose and multidose reinfusions of cardioplegic solution. The intention of this study was to determine whether glucose is beneficial in a cardioplegic solution when the end products of metabolism produced during the ischemic period are intermittently removed. The experimental model used was the isolated working rat heart, with a 3-hour hypothermic 10 degrees C cardioplegic arrest period. Cardioplegic solutions tested were the St. Thomas' Hospital No. 2 and a modified Krebs-Henseleit cardioplegic solution. Glucose (11 mmol/L) was beneficial when multidose cardioplegia was administered every 30 minutes. Including glucose in Krebs-Henseleit cardioplegic solution improved postischemic recovery of aortic output from 57.0% +/- 1.8% to 65.8% +/- 2.2%; p less than 0.025. The addition of glucose to St. Thomas' Hospital No. 2 cardioplegic solution improved aortic output from 74.6% +/- 1.9% to 87.4% +/- 1.9%; p less than 0.005. Furthermore, a dose-response curve showed that a glucose concentration of 20 mmol/L gave no better recovery than 0 mmol/L, and glucose in St. Thomas Hospital No. 2 cardioplegic solution was beneficial only in the range of 7 to 11 mmol/L. In addition, we showed that multidose cardioplegia was beneficial independent of glucose. Multidose St. Thomas' Hospital No. 2 cardioplegia, as opposed to single-dose cardioplegia, improved aortic output recovery from 57.4% +/- 5.2% to 74.6% +/- 1.9%; p less than 0.025, and with St. Thomas' Hospital No. 2 cardioplegic solution plus glucose (11 mmol/L) aortic output recovery improved from 65.9% +/- 2.9% to 87.4% +/- 1.9%; p less than 0.005. Hence, at least in this screening model, the St. Thomas' Hospital cardioplegic solution should contain glucose in the range of 7 mmol/L to 11 mmol/L, provided multidose cardioplegia is given. We cautiously suggest extrapolation to the human heart, on the basis of supporting clinical arguments that appear general enough to apply to both rat and human metabolisms.
Prolonged reversible quadriparesis in mechanically ventilated patients who received long-term infusions of vecuronium. The use of neuromuscular blocking agents, particularly pancuronium, in patients receiving mechanical ventilation has been reported to cause prolonged paralysis and atrophy. We describe two mechanically ventilated patients with asthma who developed prolonged muscular weakness and atrophy after receiving the shorter-acting agent vecuronium. These cases illustrate the potential of any neuromuscular blocking agent to cause these complications, especially in patients who are immobile, have decreased renal or liver function, or receive concomitant myotoxic agents.
Comparison of four laser types for experimental pain stimulation on oral mucosa and hairy skin. The use of different lasers for stimulation in human experimental pain research has provided a sensitive method for evaluation of thin nerve fiber functions. In this study, sensory and pain thresholds were compared to argon-, copper vapour-, Nd:YAG-, and CO2 laser stimulation on hairy skin and on oral mucosa. The influence on thresholds with respect to laser type, stimulation site, surface colour, and stimulus parameters (laser beam diameter and pulse duration) was investigated. Significant differences in thresholds between the four lasers were found on both surfaces; however, no significant differences existed between thresholds on the skin and on the tongue when the same laser was used. The observations imply that wavelength-dependent optical properties of the stimulated tissue influence on threshold determinations. Furthermore, the results indicate that temporal and spatial summation mechanisms may exist for laser induced warmth and pain perceptions. Laser stimulation may be a new tool for the investigation of origin and genesis of various orofacial pain syndromes.
Role of partial laryngectomy after irradiation in the treatment of laryngeal cancer: a view from the United Kingdom. This retrospective study evaluates the use of conservation surgical salvage techniques in cases of early (T1 and T2) laryngeal cancer after full-dose external irradiation. Fifty patients in one London hospital and 68 patients in another were studied for the period 1963 to 1988. Treatment policy directed that the majority of limited glottic and supraglottic tumors should be treated initially by external irradiation. The small number of glottic treatment failures had a good chance of salvage by vertical partial laryngectomy if recurrence or a new primary was detected early. Recurrence of supraglottic cancer was salvaged occasionally by horizontal partial laryngectomy if strict indications were observed. Total laryngectomy remained the final minority salvage option.
Radiofrequency current catheter ablation of accessory atrioventricular pathways. Tachyarrhythmias mediated by an accessory atrioventricular pathway and which are refractory to drug therapy have been treated surgically with variable success. Early results of direct-current catheter ablation were encouraging but were associated with complications such as barotrauma and the need for a general anaesthetic. We have investigated the endocardial application of radiofrequency current which is a potentially safer technique. Of 105 patients with an accessory atrioventricular pathway, 79 were located on the left side of the heart and 32 on the right side. Accessory pathway conduction was permanently abolished in 93 (89%) patients. Complications developed in 3 patients: thrombotic occlusion of a femoral artery, arteriovenous fistula formation at the site of groin puncture, and left ventricular rupture with cardiac tamponade after direct-current shocks. There were no deaths from the procedure. We conclude that radiofrequency current catheter ablation is both effective and safe for patients with symptomatic tachyarrhythmias mediated by accessory atrioventricular pathways.
The five-year cure rate achieved by cryosurgery for skin cancer. Cryosurgery was used to treat 3540 new basal cell and squamous cell carcinomas of the skin from 1971 to 1989; a cure rate of 98.4% was achieved. To determine the 5-year cure rate in more recent years, the results of treatment of 684 nonmelanotic skin cancers from 1980 to 1984 were reviewed. In the group of 628 basal cell carcinomas, the 5-year cure rate was 99.0%. In the group of 52 squamous cell carcinomas, the 5-year cure rate was 96.1%. In the series were also four patients with basosquamous cell carcinomas, all of whom were recurrence free for 5 years or more. The overall 5-year cure rate in the 684 cases was 98.8%. On the basis of these data and our cosmetic results, we conclude that cryosurgery is an effective treatment that compares favorably with other established methods of therapy.
Treatment of fetal supraventricular tachycardia with flecainide acetate after digoxin failure. Transplacentally administered digoxin is the drug of choice for the treatment of fetal supraventricular tachycardia. We describe a case of fetal supraventricular tachycardia associated with fetal hydrops that did not respond to digoxin treatment because of a lack of transplacental passage. In contrast, flecainide acetate crossed the placenta and cured the fetus. The clinical implications of this new treatment are discussed.
Use of trabeculectomy with postoperative 5-fluorouracil in patients requiring extremely low intraocular pressure levels to limit further glaucoma progression. The authors conducted a randomized, controlled clinical trial to quantify the effect of 5-fluorouracil (5-FU) on filtration surgery. Both eyes of 17 patients with either bilateral low-tension glaucoma or advanced chronic open-angle glaucoma that would be expected to progress at intraocular pressures in the normal range were included. One eye received a full-thickness filtering procedure with a modified shell tamponade technique, and the other received a trabeculectomy with postoperative 5-FU. Follow-up was equal for both eyes and averaged 9.2 months. In eyes in the shell group, the average postoperative pressure was 10.94 mmHg, and in the 5-FU group it was 6.94 mmHg, (P = 0.0001). However, the postoperative visual acuity decrease was significantly greater in the 5-FU group (P less than 0.05). Choroidal detachments also were more frequent in the 5-FU group, but this was not statistically significant.
Transient myocardial ischemia during Holter registration before and after coronary angioplasty. PURPOSE: Revascularizing procedures like percutaneous transluminal coronary angioplasty (PTCA) aim at reducing the incidence and severity of myocardial ischemia. To evaluate this, continuous Holter ST analysis is a possible method. DESIGN: 41 patients (35 men, 6 women) with stable angina pectoris had continuous twenty-four-hour two-channel Holter registration (V5/aVF-analogous leads) recorded before and after PTCA. Transient myocardial ischemia (TM) was defined as 0.1 mV ST depression or more 80 msec after the J point for one minute or more. FINDINGS: PTCA was successful for 37 patients (90%). Eleven of these had a total of 53 episodes of TM, 36 (68%) before and 17 (32%) after PTCA (p less than 0.05). Fifteen episodes (28%) were symptomatic, and 38 (72%) were asymptomatic. Six patients had TM after successful PTCA, 5 of whom had one-vessel disease and a clinically uncomplicated course. One patient had multivessel disease, with only one vessel dilated. Follow-up angiograms for 9 of the 11 patients with TM revealed 5 restenoses. There was no significant correlation between TM after PTCA and subsequent restenosis (p greater than 0.05). IMPLICATIONS: TM is common in patients with stable angina pectoris. The incidence significantly decreases after successful PTCA, but TM is seen also with a clinically uncomplicated course. In multivessel disease this is consistent with incomplete revascularization, whereas in single-vessel disease the most likely cause is intermittent spasm or thrombosis. TM after successful PTCA does not seem to be a predictor of restenosis.