shukoor65/lab-rag-model huggingface dataset:
Assessment of severity of coronary narrowings by quantitative exercise echocardiography and comparison with quantitative arteriography. To determine the correlation of quantitative assessment of coronary narrowings with left ventricular functional impairment induced by exercise, 57 patients with 1-vessel coronary artery disease and without evidence of collateral flow were studied. A significant relation was observed between minimal cross-sectional area, percent area stenosis, minimal lumen diameter, percent diameter stenosis and the percentage of segmental area change from rest to peak exercise in a vascular distribution territory (r = 0.76, p less than 0.001; r = -0.55, p less than 0.001; r = 0.56, p less than 0.001; r = -0.75, p less than 0.001, respectively). For minimal cross-sectional area, the best cut-off value to separate significantly patients who had a decrease in contractility at peak exercise testing from those who had a normal response was 2 mm2 (p less than 0.001); for percent cross-sectional area stenosis, it was 75% (p less than 0.001); for minimal lumen diameter, it was 0.7 mm (p less than 0.001); and, for percent diameter stenosis, it was 85% (p less than 0.001). High cut-off values for angiographic variables are necessary to separate significantly patients who have a decrease in contractility at peak exercise testing from those who have a normal response. Several patients with mild coronary stenoses may have either normal or abnormal wall motion during exercise. Thus, exercise echocardiography is a useful tool in detecting the presence of fairly severe anatomic narrowing, whereas it is of limited clinical use in the assessment of intermediate coronary atherosclerotic lesions.
Non-invasive assessment of pulmonary arterial pressure in healthy neonates. Doppler echocardiograms were carried out on 51 healthy babies three times during the first 72 hours of life to estimate pulmonary arterial systolic pressure by measuring regurgitant tricuspid jet velocity and applying the Bernoulli equation. Tricuspid regurgitation was detected at some stage in all preterm babies and most of those born at full term. Pulmonary arterial pressure could be measured from peak regurgitant velocity in babies with pansystolic regurgitation. The incidence of pansystolic regurgitation among 34 term babies at 0-12, 13-36, and 32-72 hours of age was 22, 27, and 19%, and in 17 preterm babies (within the same age groups) was 53, 50, and 31%, respectively. Estimates of pulmonary artery pressure in the term babies were in accord with known catheter values. Pressure fell rapidly during the first day in all 51 babies. The ratio of pulmonary:systemic arterial pressure was comparable between the two groups throughout. Ductal flow patterns mirrored the fall in this ratio with age--bidirectional flow was associated with a ratio of between 0.88:1 and 1.22:1 and high velocity left to right flow with a ratio of between 0.49:1 and 0.66:1. Both these techniques are noninvasive ways of assessing neonatal pulmonary arterial pressure.
Beat-to-beat electrocardiographic morphology variation in healed myocardial infarction. Using high-fidelity electrocardiographic (ECG) amplifiers, we measured subtle beat-to-beat ECG morphologic variations at different phases of the ECG complex. The electrocardiograms were recorded from 49 men with a documented Q-wave myocardial infarction and from 30 age-matched normal men. Forty consecutive beats were averaged to achieve an average ECG signal from which variance could be calculated. The relative variance, defined as the ratio between the integrated variance of the examined window and the integrated variance of the ECG signal that was close to full cycle length, was calculated at QRS onset and at offset in 2 frequency bands (4 to 40 and 60 to 120 Hz). Patients with healed infarction had a relative variance of 2.1 +/- 0.5 (mean +/- standard deviation [SD]) at QRS offset (a window of 40 ms), which was significantly lower than that of the healthy volunteers: 2.5 +/- 0.33 (mean +/- SD; p less than 0.02) at the low-frequency band. At the high-frequency band, patients with healed infarction had a significantly higher relative variance than the control subjects at QRS onset: 1.95 +/- 0.58 vs 1.55 +/- 0.35 (mean +/- SD; p less than 0.005). A model based on the numerous minor conduction abnormalities that exist in the chronically ischemic myocardium is presented to explain the changes in variance at the onset and offset of the QRS. The variance changes described can eventually serve as quantitative indexes of myocardial injury and electrical stability in patients with ischemic heart disease.
Patient acceptance of Nordiject: a new drug delivery system for growth hormone. Twenty-seven children, aged 5-20 years, with growth retardation were enrolled in an open study to evaluate the acceptability of a new injection pen (Nordiject 24, Novo Nordisk A/S) for administration of recombinant human growth hormone (r-hGH). Prior to this study, 17 of the patients had been receiving treatment with r-hGH administered via syringes and vials; their experiences with this conventional technique have been used for comparison with Nordiject. The injection pen is provided with a replaceable 27-gauge needle and a cartridge containing 24 IU of reconstituted r-hGH (12 IU/mL). A benzyl alcohol 0.9% solution is used as the solvent for the reconstitution. The pen can be regulated for doses from 0.5 to 8 IU per injection; regulation is accomplished by a turning movement. The patients had no problems with the dissolving procedure or handling the pen. Nearly two-thirds of the patients experienced less injection pain with the pen as compared with the syringe. Special attention was paid to local tolerability, which was reported to be good. The thigh was the preferred injection site. The residual contents from 68 cartridges returned by the patients were analyzed for microbial contamination. Contamination was detected in only one cartridge, which could not be confirmed in a repeated test. Because of the simplification of the injection procedure afforded by the injection pen, 20 of 27 patients were able to perform the injections themselves and hence assume a more active role in their treatment. The patients who previously had been using conventional syringes strongly preferred the pen, and all patients wished to continue using the device.
Aspiration cytology of breast. Most primary malignant epithelial neoplasms and many benign lesions of the breast possess such characteristic cytologic features that they can be diagnosed with certainty by needle aspiration. Because inadequate sampling may result in a false-negative cytology diagnosis, the time-tested rule is that a negative cytologic diagnosis is not definitive unless it is fully supported by negative clinical and mammographic findings.
Obstructive sleep apnea during pregnancy. Therapy and implications for fetal health. A 32 yr-old woman in her last trimester of pregnancy was found to have severe obstructive sleep apnea (OSA). The overnight polysomnogram demonstrated an apnea plus hypopnea index of 159 events per hour. Apneas were associated with severe oxygen desaturation to 40% during rapid eye movement sleep, maternal bradycardia, and second degree heart block. External cardiotocography showed normal fetal heart rate reactivity to fetal movements, even during the apneas and episodes of oxygen desaturation. Nasal continuous positive airway pressure at a level of 15 cm H2O effectively treated the apneas and desaturation and had no effect on the fetal heart rate. The patient was induced electively during the 39th wk of pregnancy and gave birth to a newborn with growth retardation. Early recognition and treatment of OSA in pregnancy might prevent problems with fetal development.
Short-term effect of albuterol, delivered via a new auxiliary device, in wheezy infants. In a double-blind, placebo-controlled study, the response of lung function to albuterol, topically administered by a metered-dose inhaler (MD) through a baby-adapted auxiliary device, was evaluated in 36 wheezy infants (1.6 to 25.2 months of age; median 8.1 months). The auxiliary device contains an air chamber of 350 ml and two low-resistant valves separating the inspiratory from the expiratory line. After baseline lung function measurements by infant whole-body plethysmography, the patients were randomly assigned to inhale either three times two puffs albuterol (100 micrograms/puff) or three times two puffs placebo at 5-min intervals. Changes in the degree of pulmonary hyperinflation, estimated by thoracic gas volume (TGV) and/or in the degree of bronchial obstruction, estimated by thoracic gas volume (TGV) and/or in the degree of bronchial obstruction, estimated by airway conductance (Gaw), were measured at 5-min intervals for up to 30 min. TGV and Gaw were expressed as standard deviation scores (SDS) of values predicted, and patients improving TGV and/or Gaw more than 2 SD were considered responders. In comparison with placebo, a significant percentage improvement in TGV (by the mean 26 to 53%) and a significant percentage improvement in Gaw (by the mean 34 to 51%) could be found in the active treatment groups. The study documents the usefulness of a new auxiliary device for the administration of aerosolized bronchodilators to wheezy infants.
Household pets and human infections. Because many Americans keep a wide variety of household pets, they are exposed to the many pet-associated diseases that are transmitted in various ways, including through bites, scratches, saliva, excreta, and respiration. This article briefly describes a number of the illnesses that may be acquired from household pets.
Scalp tumours mimicking encephaloceles. Two neonates presented with benign scalp tumours that mimicked encephaloceles. In the more recent case ultrasonography confirmed that the tumour was extracranial.
Dementia presenting with aphasia: clinical characteristics. Dementia, a disorder of multiple cognitive functions, may atypically present as an aphasia. The clinical characteristics are reported of 13 patients with up to 14 years of progressive language impairment before developing dementia. In reviewing the literature, it was found that these patients were similar to those reported with progressive aphasia. It is concluded that dementia may present with an anomic, dysfluent language disorder due to the focal left sylvian onset of several dementing illnesses.
Functional assessment of neurologic impairment: track analysis in diabetic and compression neuropathies. A laboratory approach to measuring neurologic impairment has been developed that is applicable to systemic disease as well as localized nerve injury. This approach compares individual parameters of the experimental rat hind footprint (walking track) with weight- and sex-matched control track parameters; classic mathematical indexing is not utilized. The normal track data obtained for the Sprague-Dawley rat showed a significant increase in print length (PL), toe spread (TS), and intermediate toe spread (ITS) with increasing rat weight. A significant difference between male and female rats above 400 gm also was noted. For a localized injury (sciatic nerve cut), this approach demonstrated that the contralateral hind footprint was a "compensated" rather than a normal track. This approach to track analysis also was capable of demonstrating progressive neurologic impairment for a sciatic nerve compression model and a systemic disease such as diabetes, as well as demonstrating reversal of these abnormal patterns when the "disease state" was treated.
Human immunodeficiency virus exanthem. The human immunodeficiency virus (HIV) exanthem can be the primary manifestation of HIV infection. We report three cases of an exanthematous skin eruption associated with acute HIV infection. HIV antigen (p24 core antigen) was present, whereas results of the HIV antibody test were negative.
Retinoic acid-induced growth inhibition of a human myeloma cell line via down-regulation of IL-6 receptors. In this report we demonstrate that retinoic acid (RA) down-regulated the number of IL-6R on human leukocyte cell lines, including the myeloma cell line AF10, and two B cell hybridomas that correspond to cells at earlier stages of B cell development. Using AF10 cells, whose growth was determined to be mediated by the autocrine action of IL-6, we found that RA reduction of IL-6R was concentration-dependent over a range of 10(-11) to 10(-5) M and corresponded to the ability of the retinoid to inhibit cell proliferation. The down-regulation of IL-6R number by RA was accompanied by reduced IL-6R mRNA expression. RA did not affect endogeneous IL-6 synthesis or secretion from AF10 cells. However, addition of exogenous rIL-6 could overcome RA-induced growth inhibition. Menthol, a structurally unrelated compound to RA, also suppressed IL-6R expression and, correspondingly, inhibited cell growth. Taken together, our results suggest that the antiproliferative action of RA on AF10 cells is caused by reduction of IL-6R expression and subsequent inhibition of IL-6-mediated autocrine growth. These findings suggest the possibility that down-regulation of IL-6R is a means by which RA can modulate immune function.
Requirement of heparin for arterial and venous thrombolysis with recombinant tissue-type plasminogen activator. The effect of concomitant intravenous (IV) heparin (200 U/kg bolus, followed by 100 U/kg/h) on the efficacy of arterial and venous thrombolysis with IV recombinant tissue-type plasminogen activator (rt-PA; 0.5 mg/kg over 1 hour) was investigated in a combined femoral arterial and venous thrombosis model in the dog. The arterial model consisted of a high-grade stenosis, endothelial damage, and a thrombotic occlusion, and the venous model consisted of a 125I-fibrin-labeled blood clot. After a dose-finding pilot study in four dogs, a randomized, prospective, and blind study was performed in 20 animals pretreated with 2.8 mg/kg IV acetyl salicylic acid (ASA). The combination of rt-PA and heparin (group I, n = 10) induced early (less than 30 minutes) arterial reperfusion in seven dogs, late (greater than 30 minutes) reflow in two dogs, and persistent occlusion in one dog. rt-PA alone (group II, n = 10) was associated with early reperfusion in one dog, late reflow in three dogs, and persistent occlusion in six dogs (P = .018). Reocclusion occurred in five of nine reperfused dogs of group I and in one of four reperfused dogs of group II (P = not significant). Venous clot lysis amounted to 81% +/- 4% (mean +/- SEM) for group I and to 49% +/- 7% for group II (P less than .001). Template bleeding times increased moderately, but significantly, in group I (from 2.2 +/- 0.2 minutes at baseline to 7.0 +/- 1.4 minutes at 30 minutes, P = .006), but only marginally in group II (from 2.2 +/- 0.2 minutes to 3.6 +/- 0.7 minutes, P = .09). No systemic fibrinogen depletion was observed. Thus, the concommitant use of heparin with rt-PA accelerates arterial reperfusion and enhances venous thrombolysis in dogs pretreated with ASA. These results, obtained in a randomized prospective study design, add to a growing body of experimental and clinical evidence, indicating that thrombolytic therapy with rt-PA requires concomitant adjunctive IV heparin for optimal efficacy, even in the face of treatment with ASA.
Correlates of Beck Depression Inventory scores in an ambulatory elderly population: symptoms, diseases, laboratory values, and medications. BACKGROUND. Depression is one of the most important psychiatric disorders of older people. Between 1% and 5% of elderly persons who live in the community have major depression. Depressed elderly people are thought to be more likely to complain of symptoms such as headache, constipation, and pain than of disordered mood. The purpose of this study was to determine whether certain symptoms, diseases, or drugs used by older people correlate with scores on the Beck Depression Inventory. METHODS. Beck Depression Inventory scores were obtained in an ambulatory elderly population to identify correlates with self-reported signs, symptoms, diseases, drugs, and laboratory values. A total of 1048 participants were studied, including 712 women and 336 men. RESULTS. In this study, 13.7% of the men and 20.7% of the women had scores suggesting possible depression. A linear regression model revealed eight factors of significance in predicting scores on the Beck Depression Inventory. The most important predictors were the total number of symptoms reported by the patient (P less than .0001), and subjective complaints of memory loss (P less than .0003) and of pain in the abdomen (P less than .0004). CONCLUSIONS. Clinically, the results of this study suggest that depression is underdiagnosed in older patients and that multiple somatic symptoms are the best indicator of depression in this population.
Effect of saline infusion on urinary calcium excretion in essential hypertension. Urinary excretion of sodium and calcium was examined in hypertensive (n = 8) and normotensive (n = 7) subjects following infusion of 2% saline at a rate of 11 mL/min for 90 min. The urinary sodium excretion was 204 +/- 38 (mean +/- SEM) muEq/min in normotensives and 233 +/- 28 muEq/min in hypertensives before infusion of saline and increased maximally to 499 +/- 114 muEq/min (P less than .05) and to 928 +/- 68 muEq/min (P less than .01), respectively, after saline infusion. In normotensives, urinary calcium excretion did not change significantly; however, in hypertensives excretion increased markedly (P less than .01) from 6.1 +/- 0.7 muEq/min to 12.3 +/- 1.6 muEq/min. Plasma atrial natriuretic peptide (ANP) levels increased significantly (P less than .05) in both groups. Serum ionized calcium and plasma parathyroid hormone (PTH) levels did not change significantly. The increments of urinary sodium and calcium and of plasma ANP, as well as the preinfusion plasma PTH level, were significantly (P less than .05) higher in hypertensives than in normotensives. The present study showed that exaggerated natriuresis was accompanied by hypercalcinuria and an enhanced rise in plasma ANP in hypertensives. Basal levels of plasma PTH were elevated in hypertensives. The calcium deficiency may be attributable to a close relationship between urinary sodium and calcium, and causally related to the disturbance of sodium and volume homeostasis in hypertension, which results in exaggerated natriuresis.
In-office mental status testing: a practical guide. Elderly patients with dementia often first come to the attention of their primary medical care providers. Evaluation of cognitive functioning is an important part of the diagnostic work-up, since dementia is a disorder defined by problems of mental or cognitive abilities. Mental status examination in the physician's office can provide diagnostically valuable information and prove useful for determining the need for referral for formal neuropsychological testing. This article briefly describes the cognitive changes associated with dementia and explains proper administration and interpretation of the Mini-Mental State Examination, a quantitative screening test of cognitive function.
Pain and measles, mumps, and rubella vaccination. Seventy-seven children (mean age 44.2 months) were entered in a randomised double blind study to find out if two commonly used measles, mumps, and rubella (MMR) vaccines (Pluserix and MMR II) caused pain on injection. Pain was judged by the amount of crying. Infants given MMR II were 2.31 times more likely to cry than those given Pluserix.
Early experience with low speed rotational angioplasty. OBJECTIVE--Preliminary assessment of the efficacy and safety of the low speed rotational angioplasty catheter system (ROTACS). DESIGN--Open prospective trial. SETTING--Department of cardiology in a teaching hospital. PATIENTS--Eleven patients (10 with chronic stable angina and one with acute coronary occlusion after conventional angioplasty) in whom a coronary angiogram showed occlusion or critical stenosis of the coronary artery (right in seven patients, circumflex in two, and left anterior descending in two). The nature or severity of the lesion ruled out conventional coronary angioplasty. INTERVENTIONS--An attempt was made to cross the lesion with a rotating guide wire with a blunt swelling at its tip. Where necessary progress was assessed by simultaneous injection of contrast into both main coronary arteries. MAIN OUTCOME MEASURES--Progress of the ROTACS through the lesion that allowed a guide wire to pass into the distal vessel was regarded as a device specific success. When a guide wire crossed the lesion aided only by the support of the ROTACS without the use of rotation this was counted as a success that was not device specific. Failure to cross the lesion and any associated complications were noted. RESULTS--The ROTACS crossed only two of the 10 chronic lesions (20% device specific success rate); however, the support it provided enabled a guide wire to cross a further two lesions and allowed subsequent successful angioplasty in four of the 10 patients. One of these four patients presented after five months with recurrent angina requiring bypass grafting. The other three were symptom free at follow up seven months after the procedure. In the one patient with acute coronary occlusion the ROTACS was advanced over the guide wire to allow passage of an angioplasty balloon where this had previously proved impossible. An excellent final result was obtained and this patient remains symptom free. Three of the six patients in whom the ROTACS was unsuccessful had coronary artery dissection without sequelae. Three patients required subsequent elective coronary bypass grafting for control of symptoms while the other three remain well on medical treatment. CONCLUSIONS--The ROTACS may extend the range of patients with coronary artery occlusion or critical stenosis who can be treated non-surgically. The low device specific success rate (20%) achieved in this study indicates that it should be compared with other simpler mechanical devices that may be just as effective.
The acute and chronic effects of G-lasing on femoral vein grafts in dogs. Each year, 5% of all coronary artery bypass operations are repeat procedures, and 15%-30% of coronary artery vein grafts occlude within the first eighteen months postoperatively. To evaluate the macroscopic and histologic effects of G-lasing on vein grafts and their patency, femoral veins were used to bypass bilaterally induced stenoses of femoral arteries in 10 dogs. The left vein grafts were G-lased with a 1.5 mm, hot-tipped argon laser at 5 watts for ninety seconds, while the right grafts were used as the controls. Acutely, each vein graft demonstrated no evidence of charring or perforation. The percentage of endothelium present in the G-lased vein grafts was consistently less than 5%, whereas the control vein grafts had an average of 70%. After ten weeks, the animals were sacrificed, and the vein grafts were evaluated for histologic changes and patency. There were no significant microscopic differences between the G-lased and control vein grafts. A statistically significant difference in graft patency was not achieved between G-Lased and control vein grafts at 10 weeks, but only a small number of grafts were studied. Further studies will be needed to evaluate the effects of G-lasing on the long-term patency of vein grafts.