shukoor65/lab-rag-model huggingface dataset:
Critically ischemic myocardium in clinically stable patients following thrombolytic therapy for acute myocardial infarction: potential implications for early coronary angioplasty in selected patients. The utility of post-thrombolysis, rest-redistribution thallium (TI)-201 scintigraphy was studied in 32 patients with a first myocardial infarction who were clinically stable following reperfusion. Day 1 scintigraphy obtained 5 +/- 4 hours (range 1 to 16) after thrombolysis revealed an average perfusion defect of 6.5 +/- 2.6 segments (range 1 to 11). There was a total of 208 abnormal segments, 137 of which were nonreversible at 4 hours, 50 of which were fully or partially reversible, and 21 of which had a reverse redistribution pattern. Repeat TI-201 scintigraphy on day 10 revealed significantly smaller perfusion defects of 4.9 +/- 2.4 segments (range 0 to 9) with improvement predominantly of the day 1 reversible segments, and the improvement in segmental perfusion correlated with better regional left ventricular function. Twenty-nine (58%) of the 50 reversible segments normalized by day 10, and 11 (22%) improved, whereas only 16 (12%) of 137 nonreversible segments had normalized by day 10, only 9 had (6%) improved and 112 (82%) were unchanged (p less than 0.001 reversible versus nonreversible). There was no significant change in segments with a pattern of reverse redistribution. The improvement of reversible segments was greater in the 16 patients who underwent coronary angioplasty (PTCA) during the interval between the two scintigrams than in the 16 who did not. All 24 reversible segments in the PTCA group improved or normalized by day 10 compared with 16 (62%) of 26 reversible segments in the No PTCA group (p less than 0.001). Furthermore, 8 of the 10 reversible segments in the No PTCA group that did not improve actually deteriorated and became nonreversible by day 10. The minor improvement of nonreversible segments was not related to PTCA. Consistent with the findings in individual segments, the 19 patients with a reversible component on the day 1 TI-201 scintigram had significantly greater improvement in perfusion defect by day 10 than the 13 patients without a reversible component (37 +/- 33% versus 7 +/- 22% decrease in perfusion defect severity, p less than 0.05), and this improvement was greatest in the 10 patients with a reversible component who underwent PTCA. In contrast, PTCA had no impact on the perfusion defect in the 13 patients without a reversible component. Our data suggest that following thrombolytic therapy for acute myocardial infarction, viable myocardium in the reperfused zone may remain ischemic, as manifested by a reversible pattern of TI-201 redistribution at rest, and thus may be in jeopardy of gradual progression to necrosis.(ABSTRACT TRUNCATED AT 400 WORDS).
Paramedics: knowledge base and attitudes towards AIDS and hepatitis. We surveyed 420 paramedics employed by a large metropolitan fire department to determine the effects of educational seminars on their knowledge base, perceptions, and attitudes about AIDS and hepatitis B. All surveys were completed on an anonymous, voluntary, and confidential basis. Our educational efforts improved the paramedics' knowledge base concerning the medical manifestations of AIDS, identification of risk factors, modes of transmission, and means of infection control, but had no impact on paramedics' fear of contracting AIDS. While paramedics have a strong fear of contracting AIDS, we note that they underestimate their risk of acquiring hepatitis B. Only 17% of paramedics surveyed had received the hepatitis vaccine, despite attending an infectious disease seminar addressing the occupational risks of acquiring hepatitis B infections during the previous year. Further educational efforts to address the paramedics' attitudes about AIDS, as well as to encourage paramedics to recognize hepatitis B exposure as a significant personal health risk, are currently being pursued.
The role of the pathologist in the management of breast cancer. The pathologist is a consultant in breast cancer management whose responsibility is to establish the histologic diagnosis of cancer as well as its anatomic extent once sufficient tissue has been provided. The consultation also provides data that may be used to aid in selecting primary or adjuvant therapy, evaluating new therapies, estimating prognosis, and assessing outcome. Examples of such data are the TNM histopathologic classification of the anatomic extent of the cancer used for the stage grouping (T = the extent of the primary tumor, N = the absence or presence and extent of regional lymph node metastasis, and M = the absence or presence of distant metastasis); tumor size, histologic type, and histologic and/or nuclear grade; assessment of blood vessel and lymphatic vessel invasion; analysis of steroid receptors, and other special studies as appropriate.
Recurrent haemospermia--underlying urogenital anomalies and efficacy of imaging procedures. Recurrent haemospermia is often regarded as "essential". Following routine diagnostic procedures, we found an associated factor in 54 of 72 patients (75%). With one exception (prostatic carcinoma), the benign character of the disease was confirmed. Urogenital infection was the most frequent concomitant finding (50%); in 26 men chronic prostatis was diagnosed. Other disorders such as hypertension and coagulation disorders played a minor role. Additional investigation of the prostate gland and seminal vesicles by transrectal prostatic ultrasonography revealed persistent asymmetry of the latter glands as the main finding in 20 men (28%). In every case seminal vesicle carcinoma was excluded; haemorrhage due to cystic distension, inflammatory lesions or ductal obstruction was associated in all cases with congenital abnormalities, chronic urogenital infection, coagulation disorders or hypertension.
Obstructive dilatation of extrahepatic recipient and donor bile ducts complicating orthotopic liver transplantation: imaging and laboratory findings. Biliary obstruction in liver transplants is most commonly due to stricture at the biliary anastomosis. The native common bile duct typically is normal. We retrospectively studied 28 patients with choledochocholedochostomy anastomoses who had marked native and donor extrahepatic bile duct dilatation associated with clinical evidence of biliary obstruction. Operative cholangiograms were compared with postoperative cholangiograms obtained a mean of 50 weeks (range, 2-246 weeks) later. Mean caliber of the native common bile duct increased from 7.5 +/- 2.0 mm on operative cholangiograms to 14.8 +/- 3.9 mm on postoperative cholangiograms (p less than .001). Mean caliber of the donor common hepatic duct increased from 5.9 +/- 1.3 mm on operative cholangiograms to 12.8 +/- 3.8 mm on postoperative cholangiograms (p less than .001). Dilatation of the cystic duct remnant was seen in 15 patients. All patients had surgical revision to choledochojejunostomy with improved results of liver function studies in most cases. Diffuse dilatation of native and donor extrahepatic bile ducts may develop in liver transplant recipients. Typical features include native and donor extrahepatic ducts greater than 12 mm in diameter and a dilated cystic duct remnant on postoperative cholangiography in a patient with otherwise unexplained hepatic dysfunction.
Regional cerebral blood flow in developmental stutterers. Stuttering is a poorly understood communication disorder with a 1% global prevalence. Recently, there has been a resurgence of interest in a neurogenic origin for the disorder, although no research has established clear neurological differences between "developmental" (stuttering onset in childhood) stutterers and nonstutterers. We have used xenon 133 single-photon emission computed tomography to study regional cerebral blood flow (rCBF) in 20 stutterers. Analysis revealed global, absolute flow reductions. Relative flow asymmetries (left less than right) were identified in three hemispheric regions: anterior cingulate and superior and middle temporal gyri. Milder changes were found in the left inferior frontal gyrus. Stutterers had rCBF values below median for either anterior cingulate or middle temporal gyri. With one exception, severe stutterers had rCBF values below median for the anterior cingulate gyrus. All stutterers with rCBF values above median in the cingulate gyrus had rCBF values below median in the middle temporal gyrus, and severity of their disorder was either mild or moderate. Our findings suggest that stuttering is a neurogenic disorder involving recognized cortical regions of speech-motor control.
Stimulation of pancreas and gastric carcinoma cell growth by interleukin 3 and granulocyte-macrophage colony-stimulating factor. Hematopoietic growth factors have recently been well characterized by complementary DNA cloning. For human epidermal growth factor, granulocyte-macrophage colony-stimulating factor recombinant proteins have been expressed in Escherichia coli. To reduce the toxic side effects of chemotherapy on the bone marrow, recombinant human granulocyte-macrophage colony-stimulating factor and recombinant human interleukin 3 were applied to patients suffering of gastrointestinal cancers. To determine the influence of recombinant human granulocyte-macrophage colony-stimulating factor and recombinant human interleukin 3 on human pancreas and gastric cancer cell cells in vitro, a sensitive microculture test system was established that allows precise quantification of proliferation. A more than twofold enhancement of proliferation was observed by interleukin 3 and granulocyte-macrophage colony-stimulating factor in two of two cell cultures derived from gastric carcinoma cells, while two of nine cultures from pancreas carcinoma cells have shown enhanced cell growth in the presence of recombinant human interleukin 3 or recombinant human granulocyte-macrophage colony-stimulating factor. In comparison, recombinant human epidermal growth factor increased cell growth in two of two gastric and in five of nine pancreas carcinoma cultures. In general, 1-10 ng/mL of the growth factors yielded the highest growth rate, but even 1-pg amounts produced increased cell growth. Expression of messenger RNA for granulocyte-macrophage colony-stimulating factor, interleukin 3, and the oncogene HER2/neu remained undetectable in all of the tested cell lines, while the various abundance of messenger RNA for the epidermal growth factor receptor was different in each cell line. The reported results imply that the hematopoietic growth factors interleukin 3 and granulocyte-macrophage colony-stimulating factor influence cellular growth of pancreas and gastric carcinoma cells by a paracrine mechanism and may possess a more general regulatory function than originally anticipated.
Squamous cell carcinoma of the cornea. We treated two patients with primary squamous cell carcinoma of the cornea without involvement of the corneoscleral limbus. Superficial keratectomy and cryotherapy in one patient and penetrating keratoplasty in the other patient resulted in no recurrence of the tumor after 46 and nine months, respectively. Actinic damage and late manifestation caused by poor vision in both eyes of both patients may have been the risk factors for development of this tumor.
Intraocular pressure-dependent retinal vascular change in adult chronic open-angle glaucoma patients. Intraocular pressure (IOP)-dependent retinal vascular changes were investigated in 33 eyes of 33 adult chronic open-angle glaucoma (COAG) patients by measuring major retinal vascular calibers at the optic disc border before and after mean (+/- standard deviation) IOP reduction from 35.3 (+/- 7.2) to 16.5 (+/- 4.7) mmHg for 11.2 (+/- 13.5) weeks. Both mean arterial and venous calibers were significantly reduced (P less than 0.0001 for each), from 87.8 (+/- 14.2) and 128.3 (+/- 20.8) microns at high IOP to 82.0 (+/- 13.8) and 121.4 (+/- 18.5) microns at low IOP. Arterial and venous caliber decreases correlated positively with magnitude of IOP reduction (r = 0.503, P less than 0.01 and r = 0.555, P less than 0.001, respectively). While the IOP-dependent retinal arterial caliber change was highly significant in patients 55 years of age or younger (r = 0.636, P less than 0.01) and in the overall study group, it was not significant in patients older than 55 years (r = 0.205, P greater than 0.1). Age seems to be more influential than magnitude of IOP reduction in patients older than 55. Thus, diminished IOP-dependent retinal arterial caliber change in the elderly may be one factor contributing to the higher incidence and prevalence of glaucoma in this population.
Do Creutzfeldt-Jakob disease patients of Jewish Libyan origin have unique clinical features? A focus of Creutzfeldt-Jakob disease is present in Israel among Jews born in Libya. The present study examines the clinical features in this particular group of patients. In a country-wide study of Creutzfeldt-Jakob disease, we identified 114 patients; 49 were Libyan immigrants, and 65 (three of whom had Libyan ancestors) were born in other countries. The clinical presentation and evolution of the disease is very similar in patients born in Libya and others without Libyan ancestors, but it tends to be more classical in the Libyan patients, with higher frequency of myoclonic jerks and periodic EEG and a progressive course of shorter duration. The Libyan patients tend to complain more often of headache, which is most probably an ethnic expression for depression and loss of concentration. There was no difference between the familial and nonfamilial cases.
Diagnosis and treatment of cluster headache. This article classifies cluster headaches as distinct from other types of headaches and gives guidelines for diagnosis and treatment. Explanations of the pathophysiology and pathogenesis of cluster headaches are included also.
Nosocomial pneumonia and the role of gastric pH. A meta-analysis. PURPOSE: To examine the differential effect of drugs used for stress ulcer prophylaxis on nosocomial pneumonia in critically ill patients. DATA IDENTIFICATION: Computerized bibliographic search of published and unpublished research. STUDY SELECTION: Independent review of 48 randomized controlled trials of prophylaxis identified eight relevant studies. DATA ABSTRACTION: The population, intervention, and outcomes were evaluated by duplicate independent review. RESULTS: The incidence of pneumonia was lower in critically ill patients receiving antacids and/or histamine-2-receptor antagonists as compared with patients receiving no stress ulcer prophylaxis (common odds ratio 0.42, 95 percent CI 0.17 to 1.11). When stress ulcer prophylactic therapy was titrated to achieve a gastric pH of 3.5 or greater, there was a trend favoring a decreased incidence of pneumonia (0.66, 95 percent CI 0.24 to 1.78). In trials comparing sucralfate with pH-altering drugs, the common odds ratio of 0.55 (0.28 to 1.06) suggests a 45 percent risk reduction with the use of sucralfate. CONCLUSION: Stress ulcer prophylaxis with drugs which raise gastric pH does not increase the incidence of pneumonia in comparison to placebo or control therapy. The use of sucralfate is associated with a lower incidence of nosocomial pneumonia in comparison to agents which raise gastric pH. However, methodologic deficiencies, small sample sizes, and the failure to examine the effects of antacids and histamine-2-receptor antagonists separately make a large prospective randomized trial necessary to confirm or refute these findings.
Pharmacokinetic analysis of coronary venous retroinfusion: a comparison with anterograde coronary artery drug administration using metoprolol as a tracer. Plasma and myocardial tissue concentrations of metoprolol were studied in ischemic and nonischemic areas of 22 pigs after 90 (n = 19) and 16 (n = 3) min of left anterior descending coronary artery occlusion. Group A (n = 6) received simultaneous intravenous metoprolol (0.2 mg/kg body weight) and tritium-labeled (3H)-metoprolol (0.2 mg/kg) retrogradely into the coronary vein. In group B (n = 5), metoprolol and 3H-metoprolol were administered in the same way, but at half the volume to study the influence of derived coronary venous pressure on the myocardial concentration of drug. In group C (n = 3), metoprolol was given retrogradely and saline solution was infused into the left anterior descending artery before induced death to wash out metoprolol from the coronary veins. To rule out a possible influence of the development of myocardial necrosis on drug distribution, metoprolol was retroinfused after 1 min of arterial occlusion in three pigs (group D). In group E (n = 5), metoprolol (0.2 mg/kg) was infused anterogradely into the left anterior descending artery. Peak plasma concentration was significantly higher after intravenous infusion of metoprolol (1,188 +/- 503 nmol/liter) than after coronary venous infusion (417 +/- 155 nmol/liter; p less than 0.001). In groups A and B, the nonischemic myocardial concentration of metoprolol was 250 to 300 pmol/g, whether the drug was infused intravenously or into the coronary vein. Coronary venous retroinfusion, however, resulted in a substantial accumulation of metoprolol in the ischemic myocardium. In group A pigs, subendocardial myocardial concentration was 16,800 +/- 7,774, mid-myocardial 39,590 +/- 18,043 and subepicardial 57,143 +/- 29,030 pmol/g (mean +/- SE). The ischemic myocardial concentration in pigs from group B was somewhat less pronounced, probably secondary to a lower coronary venous pressure (15 +/- 3 mm Hg) with the lower volume of infusion (6.1 +/- 0.3 ml) in group B compared with 32 +/- 5 mm Hg with a 14 +/- 1 ml infusion in group A. Coronary artery anterograde administration resulted in myocardial ischemic and nonischemic zone drug concentrations similar to those observed after retroinfusion into the coronary vein. With both modes of administration, there was a transmyocardial gradient from a somewhat lower drug concentration in the subendocardium, toward an increasing level in the mid-myocardium, to the highest concentration in the subepicardial zone of the ischemic myocardium. Coronary venous retroinfusion resulted in pronounced drug accumulation in the ischemic myocardium. The derived coronary venous pressure during infusion influenced the concentration of drug.(ABSTRACT TRUNCATED AT 400 WORDS).
Uncemented total hip arthroplasty. Prospective analysis of the tri-lock femoral component. Fifty consecutive hip disease patients (56 hips) with total hip arthroplasties (THA) utilized the uncemented Tri-Lock femoral component. Forty-five patients (51 hips) were followed for an average of 46 months (range, 24-66). Forty-two patients (47 hips) were followed with clinical examination and roentgenographs, three (four hips) by telephone interview, four (four hips) were deceased, and one (one hip) was lost to follow-up evaluation. The diagnoses included osteoarthritis (30 hips), avascular necrosis (11 hips), juvenile rheumatoid arthritis (two hips), and degenerative joint disease secondary to childhood hip disorder (four hips). Of 47 hips, 34 were graded excellent, seven good, three fair, and three poor using the Harris hip score. The incidence of thigh pain was 19% at one year, but only 6% at final follow-up evaluation. Limp persisted in 19% of the patients. Of the three patients with four hips contacted by telephone, two had slight pain and two had no pain. The roentgenographic results found an alarming 38% incidence of varus shift of the components, relative to their preoperative position. The presence of a varus shift did not adversely affect the clinical results. Early experience with the Tri-Lock femoral component shows results comparable to those reported in the literature. The high incidence of femoral component shift, presumably because of geometry of the stem is of concern. Longer follow-up evaluation will be necessary to determine the fate of these uncemented THA operations.
A newly developed drug delivery system using fine particles of activated charcoal for targeting chemotherapy. Targeting chemotherapy to the metastatic lesions of the lymph nodes after surgical removal of the main tumor, a drug delivery system using ultrafine particles of activated charcoal was developed and examined for its ability to adsorb mitomycin C (MMC) and to transport MMC to the lymph system. Satisfactory results were obtained. In animal experiments, serial sampling of thoracic duct lymph by cannulation and serial samplings of peripheral vein blood after injection of MMC-charcoal solution into the subserosal space of the intestinal wall were made to study the pharmacodynamics of the lymph-blood system through analysis of MMC regression curves. Clearance (K) and half-life (t1/2) are calculated from the formula; C(t) = C(t0) X e-kt, and compared with that of MMC-saline. Activated charcoal has a proven ability to transport MMC to the lymphatic system. With activated charcoal, MMC is retained for much longer in the lymph nodes than with saline. Congestion of the lymph system was produced by ligation of the thoracic duct in CH-40, with 25% prolongation of t1/2. In conclusion, these drug delivery systems are suitable for targeting chemotherapy at lymph node metastases, and it is proven that 1500 AA Mitsubishi ultrafine charcoal is a good carrier of drug and a slow drug-release material in the lymphatics. Minimal side effects are expected because of the constant low concentrations in the general circulation.
Efficacy of ICS 205-930, a novel 5-hydroxytryptamine3 (5-HT3) receptor antagonist, in the prevention of migraine attacks. A complex answer to a simple question. ICS 205-930 Migraine Study Group. To investigate whether the novel, potent and highly selective 5-hydroxytryptamine3 (5-HT3) receptor antagonist ICS 205-930 can prevent migraine attacks, we conducted simultaneously two randomized, double-blind, placebo-controlled, multicentre, international trials, involving a total of 204 patients, suffering from classic or common migraine. Both trials had the same parallel-group design (1 month baseline observation, followed by 3 months treatment) and both produced remarkably similar results. The primary efficacy parameter was the proportional reduction in attack frequency recorded after 3 months of treatment. Twenty-two patients withdrew prematurely from the trials and could not be assessed for efficacy. Mild to severe constipation was reported by about 50% of the patients on active treatment. None of the doses of ICS 205-930 tested (50 mg, 25 mg and 15 mg daily) produced a statistically significantly better result to reduce attack frequency than did placebo. However, confidence intervals for the difference in effect with placebo were wide, indicating that 15 mg ICS 205-930 may produce a 57% reduction in attack frequency as compared to placebo. The most unusual finding was that, for all efficacy parameters, the best results were obtained with the lowest dose (15 mg), the worst results with the highest dose (50 mg) and an intermediate effect with 25 mg. Such an inverse relation between dose and efficacy suggests a bell-shaped dose-response curve, implying that doses lower than 15 mg might well prove to be more effective. Thus, the present study has produced inconclusive, but intriguing results. Lower doses should be further investigated before drawing any definite conclusion on the efficacy of ICS 205-930 in the prophylactic treatment of migraine.