shukoor65/lab-rag-model huggingface dataset:
Determination of prostate volume by transrectal ultrasound. Estimation of prostate gland volume with transrectal ultrasound may provide important information in the evaluation of benign and malignant prostatic diseases. To determine the most accurate means of volume estimation 150 patients underwent transrectal ultrasound with 15 separate methods of volume estimation. All patients underwent subsequent radical prostatectomy or cystoprostatectomy. Prostate specimen weights were compared with the results of each volume estimation method. Step-section planimetry, previously assumed to be the most accurate means of volume measurement, exhibited a Pearson correlation coefficient of 0.93. The elliptical volume, widely used as an alternative to planimetry, demonstrated a correlation coefficient of 0.90. The most accurate method to estimate prostate weight (r = 0.94) was a variation of the prolate spheroid formula, expressed as pi/6 (transverse dimension)2 (anteroposterior dimension). When different volume ranges were considered, this prolate spheroid formula provided the closest estimate of weight in glands of less than 40 gm. and those in the 40 to 80 gm. range. The most accurate method to estimate prostates weighing greater than 80 gm. was the formula pi/6 (transverse dimension)3.
Fecal carriage of Streptococcus bovis and colorectal adenomas. An association between fecal carriage of Streptococcus bovis and colorectal carcinoma has been reported. A relationship between S. bovis and colorectal adenomas has also been suggested. In the present study, the relationship between S. bovis and adenomas was investigated. Two of 18 current adenoma patients (11%) were found to have S. bovis in their stool compared with 12 of 84 controls (14%). Six of 38 patients who had ever had a diagnosis of adenoma (16%) had S. bovis compared with 8 of 64 controls (13%). These results rule out a strong association between fecal carriage of S. bovis and adenomas; however, because of the relatively small sample size, a weak to moderate association cannot be excluded.
Eicosanoids regulate tumor necrosis factor synthesis after hemorrhage in vitro and in vivo. The aim of this investigation was to determine whether PGE2 regulates TNF release in vitro and in vivo following hemorrhage. To study this, C3H/HeN mice were bled to a mean blood pressure (BP) of 35 mm Hg, maintained for 60 minutes, and then resuscitated. For in vitro studies, peritoneal (pM phi) and splenic (sM phi) macrophages obtained at 2 hours and 24 hours after hemorrhage were stimulated with LPS for 24 or 48 hours with or without ibuprofen (IBU). For in vivo studies, M phi were harvested 24 hours following hemorrhage with and without IBU treatment and stimulated with LPS for 48 hours. The decreased TNF release by pM phi but not sM phi from hemorrhaged mice was restored by IBU in vitro. IBU treatment in vivo significantly enhanced TNF release by pM phi compared with untreated hemorrhaged animals, while TNF release by sM phi was only slightly increased. These data indicate a major role of PGE2 in the regulation of TNF release by pM phi following hemorrhage.
Sex hormones in postmenopausal women with primary biliary cirrhosis. To evaluate serum sex hormone profiles in nonalcoholic postmenopausal women with liver disease, 25 women with primary biliary cirrhosis (11 in cirrhotic stage) and 46 healthy controls were studied. The patients had significantly (p less than 0.05) elevated serum concentrations of estrone and androstenedione and significantly (p less than 0.05) lower concentrations of estrone sulfate, dehydroepiandrosterone sulfate and 5 alpha-dihydrotestosterone compared with the 46 controls. Serum concentrations of sex hormone binding globulin, testosterone, non-sex hormone binding globulin-bound testosterone and non-protein-bound testosterone did not differ significantly (p greater than 0.05) between primary biliary cirrhosis patients and controls. Patients in the cirrhotic stage had significantly (p less than 0.05) higher concentrations of sex hormone binding globulin than did controls. Patients in the cirrhotic stage had significantly (p less than 0.05) higher sex hormone binding globulin and estrone sulfate levels compared with noncirrhotic patients with primary biliary cirrhosis. Otherwise, no significant differences were observed between cirrhotic and noncirrhotic patients. The observed changes in steroid concentrations may be a consequence of hepatic dysfunction.
DNA image cytometry of keratoacanthoma and squamous cell carcinoma. The distinction between the keratoacanthoma (KA) and the squamous cell carcinoma (SCC) can sometimes be difficult on the basis of histologic and clinical criteria. The possible diagnostic significance of DNA ploidy initiated the present study evaluating the DNA ploidy in paraffin-embedded tissue sections of 7 KA and 15 SCC, and fresh frozen tissue touch preparations of 15 of the same cases using the CAS 200 Image Analyzer. In paraffin-embedded tissue sections the main peak DNA index was based on normal epidermis, and ranged from 1.03 to 1.59 in KA and from 1.47-2.71 in SCC. The DNA Index (DI) discriminated KA from SCC in 17 of 22 cases (p less than 0.0007). The highest DNA content of single nuclei ranged from 9.0-18.0 picograms (pg) (DI 2.9-6.03) in KA and 14.8-38.6 pg (DI 4.0-11.03) in SCC. The highest DNA content discriminated KA from SCC in 16 of 22 cases (p less than 0.003). In fresh frozen tissue touch preparations from 15 of the same lesions, there was considerable overlap in DNA indices of KA (0.534-1.39) and SCC (0.464-1.41). Abnormal DNA peaks seen in histograms from three SCC in paraffin-embedded tissue sections were lost in the touch preparation histograms, probably due to inadequate sampling. Therefore, image analysis of paraffin-embedded tissue sections is better able to distinguish KA from SCC than touch preparations.
Use of a guideline based questionnaire to audit hospital care of acute asthma. OBJECTIVES--To design an audit questionnaire and pilot its use by an audit assistant to monitor inpatient management of acute asthma and to compare the care given by chest physicians and general physicians. DESIGN--Retrospective review by a chest physician and audit assistant of a random sample of 76 case records of patients by a criterion based questionnaire developed from hospital guidelines on management of acute asthma. SETTING--One district general hospital. PATIENTS--76 adult patients with acute asthma: 38 admitted with a relevant primary diagnosis between April 1988 and March 1989 and a further 38 admitted through the accident and emergency department between April 1989 and March 1990. MAIN OUTCOME MEASURES--Conformity with recognised standards for assessment and management of acute asthma before and after the audit and by chest physicians and general physicians. RESULTS--Age and sex did not differ significantly between the different groups of patients. Overall, deviations from the guidelines occurred in recording measures of severity of asthma, emergency treatment with beta 2 agonists (60/76, 79%) and steroids (43/76, 57%), and prescription of antibiotics in accordance with at least one criterion of the guidelines (29/45, 64%). Chest physicians were more rigorous than general physicians in recording severity measures, especially serum potassium concentration (chi 2 = 3.6, df = 1, p = 0.06), emergency steroid treatment within the correct period (chi 2 = 3.9, df = 1, p = 0.05), and referral for follow up at an outpatient chest clinic. Recording of arterial blood gas tensions improved significantly between the 1988-9 and 1989-90 samples (chi 2 = 7.0, df = 1, p = 0.08). CONCLUSIONS--The questionnaire proved easy to use for both doctor and audit assistant. The audit improved few standards of care and emphasises the need for further reinforcement and feedback.
Surgical removal of massive subretinal hemorrhage associated with age-related macular degeneration. The authors report on 11 patients with age-related macular degeneration associated with massive subretinal hemorrhage, who were treated with surgical removal of the hemorrhage and associated fibrosis. Preoperative visual acuity ranged from 20/400 to hand motions. Postoperative visual acuity ranged from 20/200 to light perception with a minimum of 3 months of follow-up. Complications included partial or total retinal detachment in four patients (36%) and cataract in four patients (36%). Four of 11 patients showed some improvement in vision (36%). All four of these patients had surgery within 1 week of the onset of severe visual loss. Although surgical removal of large subretinal hemorrhages is technically feasible, visual recovery is limited, even in uncomplicated cases, by macular degenerative changes.
Bilateral parotid secondaries from primary bronchial carcinoid tumour. Three years following a right lower lobectomy for primary carcinoid tumour of the bronchus, a patient presented with bilateral parotid masses. On investigation, both these were shown to be carcinoid tumours, consistent with metastatic spread from the primary bronchial tumour. This unique case is presented together with a discussion of the diagnostic methods employed.
Serious infections involving the CDC group Ve bacteria Chryseomonas luteola and Flavimonas oryzihabitans. Chryseomonas luteola and Flavimonas oryzihabitans are phenotypically similar gram-negative bacilli and are also referred to as CDC groups Ve-1 and Ve-2, respectively. These bacteria are rarely reported as pathogens in humans. Infections described in the literature include primarily bacteremia in critically ill patients and peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. We describe three cases of polymicrobial infection secondary to infection with group Ve organisms, including the first reported case (to our knowledge) of CNS infection due to F. oryzihabitans. These three cases and a review of literature suggest an association between the presence of indwelling catheters and polymicrobial infections with CDC group Ve organisms. F. oryzihabitans and C. luteola should be added to the expanding list of nosocomial pathogens with a propensity to infect critically ill patients who have undergone surgical procedures and/or had indwelling catheters placed. The isolation of either of these organisms from clinical specimens should prompt a search for a device-related source.
Independent genetic determinants of pancreatic and pulmonary status in cystic fibrosis The concordance of pancreatic and pulmonary status among siblings with cystic fibrosis, the cystic fibrosis genotype, and non-genetic factors were analysed in adult patients with cystic fibrosis. Genetic factors were more important than non-genetic factors in affecting the severity of pancreatic and lung disease. The genetic factors were independent of each other and did not invariably cosegregate with specific mutations at the cystic fibrosis locus.
Self-reported sleep quality in HIV infection: correlation to the stage of infection and zidovudine therapy. We investigated self-reported sleep quality in a group of 50 patients in different stages of HIV-1 infection by using a standardized questionnaire (Pittsburgh Sleep Quality Index). Alterations of sleep were found to be significantly correlated with the most severe stage of infection in AIDS patients. Analysis of data failed to indicate a significant influence of zidovudine on self-reported sleep quality.
Real-time digital contrast enhancement and magnification in the assessment of acute elbow injuries. The elbow is a common site of injury and missed fractures may lead to disability and litigation. An assessment was made of a commercially available desk-top digital contrast enhancement and magnification unit (DETECT system) in a series of 320 patients with an acute elbow injury. Five radiologists of varying experience independently viewed elbow radiographs on a conventional light-box, and subsequently using the digitizer, indicating the presence or absence of a fracture. The overall results demonstrated no difference in performance when using the unit, though small improvements in the confidence with which a definite diagnosis was made were observed. Assessment of soft tissues with the digitizer was less reliable.
Transtelephonic electrocardiographic monitoring of cardiac rehabilitation exercise sessions in coronary artery disease. Transtelephonic monitoring of a single-lead electrocardiogram and on-demand 2-way voice communication were accomplished at 1,865 exercise sessions for 67 cardiac patients. Exercise sessions occurred either at the patients' homes or at remote hospital sites and began an average of 25 or 14 weeks, respectively, after hospital dismissal. Monitoring centers provided experienced nurses to direct all exercise sessions. The transtelephonic monitoring equipment was reliable with only one instance of system failure observed. A broad spectrum of patients with coronary artery disease, including some classified at higher risk, participated in the program. Patients exercised with a variety of equipment (cycle ergometer, treadmill, arm ergometer, cross-country ski simulator, combination arm-leg cycle ergometer, rowing machine), for 30 to 50 minutes, 1 to 3 times each week. No medical emergencies occurred, although 18 specific problems were discovered that led to further evaluation or change in the medical program of specific patients. Transtelephonic monitoring of cardiac rehabilitation exercise sessions at home and at remote hospitals appears safe and is attractive because not all patients have access to supervised exercise programs; this exercise assessment helps to maximally use highly trained cardiac rehabilitation personnel.
Ibopamine in the treatment of heart failure. Efficacy and safety of a drug are essential criteria to be fulfilled before a new drug receives recommendation. This review focuses on the safety of ibopamine in the treatment of chronic heart failure. Ibopamine is a new, orally active drug with a predominant action on dopaminergic adrenoceptors. As a result, it reduces systemic vascular resistance, increases cardiac output, and increases renal flow. Ibopamine also modulates the neuroendocrine reflexes in heart failure; plasma renin activity and norepinephrine and aldosterone plasma concentrations are reduced, both immediately and during sustained administration. Ibopamine has proved to be safe in many thousands of heart failure patients during long-term therapy. This argues well for its use as an alternative or additive therapy in the treatment of patients with chronic heart failure.
Myocardial reperfusion injury. Platelet-activating factor stimulates polymorphonuclear leukocyte hydrogen peroxide production during myocardial reperfusion. To study the roles of platelet-activating factor, polymorphonuclear leukocytes, and oxygen free radicals in myocardial reperfusion injury, we subjected 10 sheep to 90 minutes of mid-left anterior descending coronary artery followed by 6 hours of reperfusion. Stainings with gentian violet and tetratriphenyl ammonium chloride demonstrated 20% +/- 3% of the left ventricular mass at risk for ischemia, of which 75% +/- 10% underwent infarction. Coronary sinus blood was assayed for platelet-activating factor and neutrophil hydrogen peroxide production before and during coronary occlusion and during reperfusion. Platelet-activating factor was isolated by column chromatography and lipid extraction and quantified by radioimmunoassay. Neutrophil hydrogen peroxide production was measured by a 2',7'-dichlorofluorescein flow-cytometric assay. Platelet-activating factor was elevated to 899 +/- 210 pg/ml at 15 minutes of reperfusion, compared with the preocclusion level of 271 +/- 55 pg/ml and coronary occlusion level of 359 +/- 64 pg/ml (p less than 0.05; analysis of variance). Neutrophil hydrogen peroxide production, measured on a relative fluorescence scale, was also elevated to a level of 141 +/- 27 at 1 hour of reperfusion, compared with the preocclusion level of 103 +/- 6 and the coronary occlusion level of 114 +/- 13 (p less than 0.01; analysis of variance). Both of these parameters returned toward baselines at the end of 6 hours of reperfusion. Histologic examination revealed infiltration of polymorphonuclear leukocytes into the interstitium of the reperfused myocardium. Neutrophils isolated from unoperated and healthy sheep demonstrated a graded dose response in hydrogen peroxide production when stimulated by purified platelet-activating factor in vitro. These findings suggest that platelet-activating factor is released in the coronary circulation and is a mediator of oxygen free radical production in polymorphonuclear leukocytes during myocardial reperfusion.
Have general hospitals become chronic care institutions for the mentally ill? OBJECTIVE: Dramatic increases in lengths of stay for general hospital psychiatric patients in New York City in recent years have raised speculation that general hospitals are assuming a large responsibility for care of the chronically mentally ill. This study examines changes in utilization patterns and patient characteristics to assess whether such a trend is occurring. METHOD: The authors obtained discharge abstract data for all New York City general hospital adult psychiatric patients in 1985 and 1988 as well as utilization data from the public general hospital system for 1977-1989. Three measures of chronicity were chosen: hospital stays longer than 60 days, discharges to long-term care, and three or more admissions per year. Data on psychiatric diagnoses and comorbid diagnoses for chronically ill patients were also reviewed. RESULTS: The mean length of stay of psychiatric patients in general hospitals has increased substantially in recent years and nearly tripled in the public hospitals during 1977-1989. Between 1985 and 1988, citywide increases were due largely to a growing proportion of patients with very long stays. Patients with stays longer than 60 days accounted for 35% of all inpatient days in 1988, compared with 27% in 1985. Patients with chronic illness accounted for half of all days in 1988, compared with 38% in 1985. CONCLUSIONS: Although many factors have contributed to these trends, the leading cause has been reimbursement policies favoring short-term inpatient care. Improving accountability for community treatment programs will be the key to redirecting funding priorities and creating more appropriate alternatives for the chronically mentally ill.
Failure of early electrocardiogram to predict successful thrombolysis. Effect of stunned myocardium? We investigated the value of the modified Selvester QRS score in predicting reperfusion in 74 patients with an acute myocardial infarction who were treated with intravenous streptokinase. Coronary angiography and time to peak creatine kinase level were used to determine the success of thrombolytic therapy. At 6 weeks a significant difference was seen between the QRS score of the patients in whom thrombolysis was successful compared with those in whom there was no reperfusion. There was, however, no difference between the QRS score of these groups of patients at 1 week. The ejection fraction at 1 week was 60% and 51%, respectively. The failure of the early electrocardiogram to predict reperfusion and improved left ventricular function may be a consequence of the stunned myocardium.
Lack of gastric acid rebound after stopping a successful short-term course of nizatidine in duodenal ulcer patients. To assess whether there is rebound of gastric acidity after a short-term course of H2-receptor antagonists, we performed a 24-h in situ pH monitoring on 17 duodenal ulcer patients before, during, and after completing 4 wks' treatment with nizatidine 300 mg at bedtime (2200 h). Three around-the-clock continuous intragastric pH-metries were carried out the day before beginning treatment, at the end of the nizatidine course, and 67 h after the last dose of the drug was given. Nizatidine produced mean pH values that were significantly higher (p less than 0.001) than those of the pretreatment profile during both the whole 24-h period and the nighttime (2400-0759), and this confirms that it effectively inhibited gastric acidity. Conversely, there was no significant difference between the acidity indexes of pH profiles obtained before dosing and after discontinuing treatment in any of the time intervals considered. Therefore, it appears that a short term course of nizatidine therapy does not cause rebound hyperacidity in duodenal ulcer patients.
PET measurements of hyperthermia-induced suppression of protein synthesis in tumors in relation to effects on tumor growth. Hyperthermia-induced metabolic changes in tumor tissue have been monitored by PET. Uptake of L-[1-11C]tyrosine in rhabdomyosarcoma tissue of Wag/Rij rats was dose-dependently reduced after local hyperthermia treatment at 42, 45, or 47 degrees C. Tumor blood flow, as measured by PET with 13NH3, appeared to be unchanged. The L-[1-11C]tyrosine uptake data were compared to uptake data of L-[1-14C]tyrosine and with data on the incorporation of L-[1-14C]tyrosine into tumor proteins. After intravenous injection, the 14C data were obtained from dissected tumor tissue. Heat-induced inhibition of the incorporation of L-[1-14C]tyrosine into tumor proteins tallied with the L-[1-11C]tyrosine uptake data. Heat-induced inhibition of amino acid uptake in the tumor correlated well with regression of tumor growth. It is concluded that PET using L-[1-11C]tyrosine is eligible for monitoring the effect of hyperthermia on tumor growth.
Aortic valve reconstruction in Rubinstein-Taybi-syndrome: the valuable aid of transesophageal echocardiography. A fourteen year old boy with Rubinstein-Taybi-syndrome presented with a severe congenital subvalvular fibrous aortic stenosis with associated aortic regurgitation. Transthoracic echocardiographic imaging and left heart angiography showed a transvalvular peak systolic pressure gradient of 90 mmHg and a regurgitant fraction of 30%. The surgical treatment consisted of resection of the subvalvular fibrous tissue and subsequent aortic valvuloplasty. Intraoperative transesophageal echocardiography revealed a wide systolic opening of the aortic valve and good coaptation of the aortic valve leaflets in diastole. Two-dimensional color-coded and contrast echocardiography were successfully used to confirm a satisfactory reconstruction. Transesophageal echocardiography therefore represents a valuable tool in the assessment of the morphologic and haemodynamic status, especially in rare cases of congenital heart disease in older children.