shukoor65/lab-rag-model huggingface dataset:
Physiologic and anatomic assessment of patients with rectocele. Clinical, physiologic, and anatomic assessments were carried out in 22 female patients with symptomatic rectocele (Group A), 15 patients with asymptomatic rectocele (Group B), and 14 subjects having no rectocele (Group C). Resting and pressure, rectal pressure, rectal compliance, anorectal inhibitory reflex, and rectal sensation did not differ among the groups. Proctography revealed that the lengths of the rectocele during attempted defecation in groups A (1.6 [1.0-3.5] cm) (median and range) and B (1.6 [1.0-3.0] cm) were significantly greater than that in Group C (0.4 [0.1-0.9] cm) (P less than 0.001 in both groups). Median pelvic floor descent at rest in Groups A (4.3 [1.6-7.5] cm) (median and range) and B (4.3 [1.3-6.9] cm) were significantly greater than that in Group C (2.5 [1.2-5.0] cm) (P less than 0.001 and P less than 0.02, respectively). These results indicate that rectocele is not associated with any physiologic change apart from a significant increase of pelvic floor descent.
Final report on the second British Institute of Radiology fractionation study: short versus long overall treatment times for radiotherapy of carcinoma of the laryngo-pharynx. The second British Institute of Radiology trial of dose fractionation in radiotherapy compared two groups of prospectively randomized patients with squamous carcinoma of the laryngo-pharynx; one group was treated in a short (less than or equal to 4 weeks) and the other in a long (greater than 4 weeks) overall time. Treatment in any one centre could be given, with no planned gap in the course of treatment, either as a conventional, daily (5 fractions per week regime) or as 3 fractions per week. A total of 611 patients were allocated to treatment, of whom nine have had to be excluded from the analysis for a lack of information. Patients were admitted to the trial from January 1976 to December 1985 and were followed up for a maximum of 10 years and a minimum of 3 years. A reduction in total dose was made for use in the short compared with the long treatment regime. This reduction in total dose varied between 18% and 22% depending on whether 5 fractions or 3 fractions per week regimes were used. Overall, no statistically significant differences have been found between the two arms of the trial. The patients treated with 5 fractions per week in a short overall treatment time showed fewer late normal tissue effects. An analysis based on stratification by age, stage and anatomical site gave a relative risk (short/long overall treatment time) for deaths of 1.23 with a 95% confidence interval from 0.96 to 1.59. Analyses stratified for stage and site gave relative risks with 95% confidence intervals of 1 x 10 (0.84-1.44) for local recurrences/tumour persistence, and 1.01 (0.70-1.45) for laryngectomies.
Prevalence and natural history of otitis media with perforation in Maori school children. New Zealand Maoris are one of five ethnic groups in developed countries known to have a high rate of ear disease, including perforation of the eardrum (CSOM). It is a strongly held belief by otolaryngologists whose practice dates back to the 1960's that the prevalence of CSOM in Maori children is gradually falling. Despite the obvious practical implications this change has not yet been documented. The aim of the study was to compare the prevalence of CSOM in two surveys conducted in 1978 and 1987 of children living in a North Island Maori community. A second aim was to examine the natural history of CSOM in these children. The raw data from the 1978 study were reviewed. Of 134 children aged 4-13, 12 had CSOM. In 1987 the same age group yielded 12 children out of 250 with CSOM. The prevalence of CSOM fell from 9 per cent to 4 per cent. The incidence of new perforations in 1987 was 1.3 per cent per child per year. It is concluded there has been a fall in the rate of CSOM, although otitis media remains a significant problem for these children. The probability of a perforation healing was influenced by whether or not the perforation had been observed before: at least 35 per cent of perforations seen for the first time healed, but none of the perforations seen on two occasions healed spontaneously. It was concluded that perforation of the eardrum can be managed conservatively at first.
Persistent bile leak after liver transplantation: biloma drainage and endoscopic retrograde cholangiopancreatographic sphincterotomy. Persistent bile leaks after liver transplantation were successfully treated in three patients with percutaneous or surgical drainage of bilomas and endoscopic retrograde ampullary sphincterotomy. In all three patients, biliary anastomoses were achieved by means of choledochocholedochostomies, with a T-tube stent in the anastomosis. The bile leaks led to subhepatic bilomas that had persistently high catheter outputs (greater than 200 mL per 24 hours) for longer than 1 month. Biloma drainage decreased shortly after sphincterotomy.
Combined pterional-anterolateral approaches to cranial base tumors. Advanced tumors of the paranasal sinuses, parotid gland, orbit, parapharynx, and cranial cavity may invade the infratemporal fossa by direct extension or through natural anatomic pathways. The inability to control disease involving this region is reflected by the unacceptably high recurrence rates for both intracranial and extracranial neoplasms. Between 1983 and 1986, a pterional (or subtemporal) approach was combined with such conventional anterolateral procedures as a mandibulopharyngectomy, maxillectomy, orbitectomy, and parotidectomy in 13 patients with advanced skull base lesions. The tumor origin was extracranial in ten cases and intracranial in three patients. Seven of the neoplasms were malignant and six were histologically benign. Complete tumor removal was achieved in all patients. Repair of the ablative defect was achieved with a temporalis myogenous flap in ten patients, and primary closure or distant myocutaneous flaps in the remaining three patients. Postoperative complications included three lateral nasocutaneous fistulae secondary to temporalis myogenous flap necrosis and isolated cases of stroke, cerebral edema, pneumocephalus, and cerebrospinal fluid rhinorrhea. Twelve patients are alive without evidence of disease at a mean interval of 25 months. The remaining patient died from lung metastases 11 months after surgery.
Clinical role of respiratory virus infection in acute otitis media. The clinical characteristics of acute otitis media in relation to coexisting respiratory virus infection were studied in a 1-year prospective study of 363 children with acute otitis media. Respiratory viruses were detected using virus isolation and virus antigen detection in nasopharyngeal specimens of 42% of the patients at the time of diagnosis. Rhinovirus (24%) and respiratory syncytial virus (13%) were the two most common viruses detected. Adenovirus, parainfluenza viruses, and coronavirus OC43 were found less frequently. The mean duration of preceding symptoms was 5.9 days before the diagnosis of acute otitis media. Ninety-four percent of the children had symptoms of upper respiratory tract infection. Fever was reported in 55% and earache in 47% of cases. Patients with respiratory syncytial virus infection had fever, cough, and vomiting significantly more often than patients with rhinovirus infection or virus-negative patients. No significant differences were found in the appearance of the tympanic membrane and outcome of illness between virus-negative and virus-positive patients with acute otitis. Most patients respond well to antimicrobial therapy despite the coexisting viral infection. If the symptoms of infection persist, they can be due to the underlying viral infection, and viral diagnostics preferably with rapid methods may be clinically useful in these patients.
Rationale for the use of 5-HT1-like agonists in the treatment of migraine. Migraine headache is thought to be associated with a dilatation of cranial blood vessels, particularly those in the dura mater, and an accompanying localized sterile inflammatory response. Sumatriptan is a highly selective 5-HT1-like receptor agonist which selectively constricts cranial blood vessels (including those in the dura mater). It also inhibits neurogenically-mediated plasma protein extravasation in the dura mater. Haemodynamic studies in anaesthetized animals have shown that sumatriptan selectively constricts the carotid arterial circulation and this effect appears to be restricted to an effect on carotid arteriovenous anastomoses. Sumatriptan has a much more selective pharmacological profile than ergot preparations which are also used in the acute treatment of migraine. The development of sumatriptan has been based on a vascular theory of migraine and its high degree of efficacy in the treatment of migraine strengthens the argument that dilatation of cranial blood vessels is the cause of vascular headache.
Abdominal pain in HIV infection. The causes of abdominal pain in patients with AIDS are different from those of the general population, and there are no guidelines as to which investigations are optimal. We reviewed our experience of 63 patients who presented with abdominal pain as the main reason for admission to the AIDS unit at St Stephen's and Westminster Hospital between January 1988 and January 1990. All patients were assessed within the same structured diagnostic programme. Thirty-five had upper abdominal pain, predominantly in the right upper quadrant in 27; seven had lower abdominal pain, which was concentrated in the right iliac fossa in three; 21 had diffuse abdominal pain. The causes of pain were determined satisfactorily in the majority of patients using routine gastroenterological investigations. The predominant site of pain had considerable predictive value in the diagnosis. The commonest cause of right upper quadrant pain was sclerosing cholangitis (17 of 27); endoscopic retrograde cholangio-pancreatography was necessary for a confident diagnosis. Diarrhoea was frequently associated (15 of 21) with diffuse abdominal pain; the commonest cause (six of 21) was cytomegalovirus colitis. Neoplasia was the cause of abdominal pain in eight patients. The other causes of abdominal pain and the utility of various investigations are discussed. An investigatory route which may provide maximum information has been suggested.
Incomplete lower esophageal sphincter relaxation in subjects with peristalsis: prevalence and clinical outcome. Incomplete lower esophageal sphincter relaxation is recognized in achalasia and has been reported in subjects with esophageal spasm. We reviewed 500 consecutive manometric studies from a 3-yr period to determine the prevalence of this manometric finding, its association with other motility abnormalities, and the clinical outcome of subjects without associated aperistalsis (i.e., without achalasia). We identified 60 subjects with incomplete lower sphincter relaxation, 17 of whom had at least some normal peristalsis (3.4% of the total). Mean lower sphincter residual pressure for these 17 subjects (4.5 +/- 2.8 mm Hg) was intermediate between those with achalasia (11.7 +/- 6.8 mm Hg) and those with normal relaxation (0.1 +/- 0.2 mm Hg). Both peristaltic and contraction abnormalities in the esophageal body were prevalent in the 17 subjects compared with those who had normal relaxation. Outcome with conservative medical therapy after a mean follow-up of 3.3 yr was not significantly related to presence of peristaltic or contraction abnormalities at presentation, and 71% of subjects with or without these concomitant findings had improvement or complete resolution of symptoms. Only one subject worsened and was treated with pneumatic dilation. We conclude that incomplete relaxation of the lower esophageal sphincter without aperistalsis is uncommon, symptom regression occurs with conservative therapy, and pneumatic dilation appears rarely required over a modest follow-up period.
Relation of stenosis resolution pressure to long-term clinical outcome after successful percutaneous transluminal coronary angioplasty. Variables associated with a poor long-term prognosis after successful percutaneous transluminal coronary angioplasty (PTCA) include a short duration of symptoms before PTCA, unstable angina and the presence of thrombus at the PTCA site. These imply a component of transient or dynamic obstruction as opposed to a pure fixed obstruction. It is postulated that resolution pressure (i.e., the pressure at which complete balloon inflation occurs) may also correlate with prognosis after successful PTCA. In 173 consecutive patients undergoing successful, elective, single-lesion PTCA, 48 (28%) were found to have narrowings that resolved at less than or equal to 2 atm (group 1) and 125 (72%) were found to have narrowings resolved at greater than 2 atm (group 2). There were no significant differences in baseline, anatomic or procedural variables between the 2 groups, except that angiographic coronary dissection occurred in 17% of group 1 patients versus 40% of group 2 patients (p less than 0.007). During a mean follow-up of 12.0 +/- 6.1 months, the incidence of cardiac events (repeat PTCA, coronary artery bypass grafting or myocardial infarction) was 29% in group 1 versus 15% in group 2 (p less than 0.05). The overall incidence of angina was similar between the groups (25 vs 28%), but Canadian Cardiovascular Association class 4 angina occurred significantly more frequently in group 1 than group 2 (21 vs 8%) (p less than 0.04). These data suggest that a low resolution pressure is associated with a higher incidence of unstable angina and recurrent cardiac events during follow-up than higher resolution pressures.
What if Americans ate less fat? A quantitative estimate of the effect on mortality. Americans consume an average of 37% of their energy intake as fat. Many authorities recommend restricting fat intake to 30% of energy intake to reduce the rates of coronary heart disease and perhaps of cancers of the breast, colon, and prostate. Based on the assumptions that underlie those recommendations, we estimated the effect of this dietary change on mortality. If all Americans restricted their intake of dietary fat by reducing consumption of saturated fat and accompanying dietary cholesterol, the corresponding reductions in serum cholesterol levels could reduce coronary heart disease mortality rates by 5% to 20%, depending on age. If the relationship between dietary fat and cancer is as strong as has been observed in some studies, the proportional effects on mortality from fat-related cancers could be even greater, although the absolute effects--given the lower mortality rates--would be smaller. Overall, if the assumptions are correct, about 42,000 of the 2.3 million deaths that would have occurred in adults each year in the United States could be deferred. This 2% benefit, equivalent to an increase in average life expectancy of 3 to 4 months, would accrue chiefly to people over the age of 65 years. If recent concerns about the possibly harmful effects of cholesterol lowering on mortality from noncardiovascular causes--which mainly affect younger persons--are valid, these relatively modest benefits would be overestimates of the actual effect.
Near normalization of adolescent height with growth hormone therapy in very short children without growth hormone deficiency. Ten prepubertal children with stature at or below the 1st percentile for height and without growth hormone deficiency received 0.3 U recombinant growth hormone per kilogram daily for 2 years before puberty. Their growth velocity increased from 4 +/- 0.3 cm/yr before treatment to 10.7 +/- 0.6 and 8.8 +/- 0.6 cm, respectively, during the first and second years of treatment, and then remained at 5.7 +/- 0.7 cm the year after the end of growth hormone administration. This resulted in a near normalization of adolescent height. Bone maturation paralleled chronologic age, and therefore the expected final height of the children increased by approximately 10 cm. Administration of growth hormone induced a reversible hyperinsulinemia, with moderate and transient changes in glucose metabolism. A prospective, randomized study, including an untreated cohort, will be needed to confirm the effects on final height and to determine the magnitude of the response in familial short stature.
Distinction between metabolic and myogenic mechanisms of coronary hyperemic response to brief diastolic occlusion. We monitored an index of coronary vascular resistance (mean aortic pressure/mean coronary flow) in 19 heart-blocked conscious dogs paced at 60 beats/min and instrumented with an aortic pressure catheter, left circumflex artery electromagnetic flow probe, and a coronary occluder. Cessation of pacing for a single beat resulted in a long diastole control (LDC) intervention beat of 2-second duration characterized by a progressive rise in diastolic coronary vascular resistance index. A 400-msec coronary artery occlusion early in a long diastole (LD4) dramatically inhibited the rate of rise in resistance index during the first 600 msec (phase 1) after occlusion. Partial recovery of the resistance index rise rate was evident during the remaining 400 msec (phase 2) of the long diastole. In nine dogs, LDC and LD4 intervention beats were instituted during two conditions of myocardial metabolic activity in which the myogenic stimuli associated with coronary occlusion would be similar: 1) paired pacing and 2) normal pacing plus intravenous adenosine and phenylephrine infusions (AP) to maintain mean aortic pressure and coronary flow at paired pacing levels. During paired pacing, the LD4-LDC differences in phase 1 and 2 resistance index rise rates (-69 +/- 18 and -48 +/- 31 mmHg/ml/sec2, respectively) were greater than during normal pacing plus AP (-32 +/- 14 and -1 +/- 32 mm Hg/ml/sec2, phase 1 and 2, respectively) (p less than 0.05). These differences are consistent with operation of a metabolic mechanism in response to occlusion.
Sympathetic secretory response to hypercapnic acidosis in swine. We studied the effect of graded acute hypercapnic acidosis (HA) on sympathetic neural activation in 15 juvenile farm swine in vivo. In seven animals with acute HA, plasma norepinephrine (NE) concentration increased progressively from 189 +/- 34 to 483 +/- 80 pg/ml (P less than 0.04) as arterial CO2 partial pressure (PaCO2) increased in steps from 40 to 80 Torr (pH 7.17 +/- 0.01). Plasma epinephrine (EPI) concentration increased from 30 +/- 15 to 125 +/- 66 pg/ml (P = NS) over the same change in PaCO2. At PaCO2 of 110 Torr, plasma NE increased 3.4-fold above maximal basal concentrations; plasma EPI was 1.8-fold greater than basal under the same conditions. With HA, systemic vascular resistance (SVR) decreased from 1,748 +/- 110 to 1,392 +/- 145 dyn.s.cm-5 (P less than 0.0002), cardiac output (CO) increased from 3.4 +/- 0.3 to 4.3 +/- 0.3 l/min (P less than 0.01), and heart rate (HR) increased from 117 +/- 11 to 154 +/- 17 beats/min (P less than 0.03). To demonstrate that catecholamine secretion was related directly to acidosis caused by an increase in PaCO2, HCO3- was infused in eight other swine to buffer extracellular acute HA (pH 7.37 +/- 0.01 at PaCO2 of 80 Torr). Buffering attenuated the increase in plasma NE, which remained within the normal range at PaCO2 of 80 Torr. The decrease in SVR and increases in CO and HR also were also attenuated by HCO3- buffering of HA. We demonstrate the effects of graded acute HA on endogenous secretion of catecholamine and on the associated hemodynamic responses in swine.
Metabolism of 25-OH-vitamin D3 by peritoneal macrophages from CAPD patients. The active metabolite of vitamin D, 1,25-dihydroxycholecalciferol (1,25(OH)2D3), is produced mainly by the kidney, but there is evidence for extrarenal production in certain circumstances. We studied whether peritoneal macrophages (PM) from CAPD patients were capable of metabolizing 25-OH-D3 to 1,25(OH)2D3. We found that PM were able to metabolize 25-OH-D3 in vitro; the main product following 16 hours of incubation was 19-nor, 10-oxo, 25-OH-D3 with smaller amounts of 1,25(OH)2D3. However, after shorter incubations of three and five hours a larger portion of 1,25(OH)2D3 was produced. The metabolism of 25-OH-D3 was greatly enhanced in PM harvested during episodes of peritonitis. This property was specific for PM of CAPD patients, and was not found in PM from normal subjects. However, incubation of control PM with peritoneal effluent from CAPD patients resulted in induction of the ability of these cells to metabolize 25-OH-D3. This induction was enhanced by preincubation with peritoneal effluent from CAPD patients suffering from peritonitis. Prostaglandin E2 was found to be involved in this synthesis: addition of PGE2 to normal PM induced metabolism of 25-OH-D3, and incubation of PM from CAPD patients with indomethacin decreased the metabolism of 25-OH-D3. The vitamin D metabolites produced by PM from CAPD patients could have a role in immunological resistance to peritoneal infections.
Recombinant alpha interferon in metastatic renal cell carcinoma. A cooperative phase II study. A total of 61 evaluable patients with advanced renal cell carcinoma have been treated with 3 x 10(6) IU per square meter of body surface with recombinant alpha 2b interferon three times a week within a Cooperative Phase II Study. Toxic death for terminal renal failure occurred in 1 patient (1.63%), and toxicities greater than WHO grade 2 were present in 10 cases (16%). The overall response rate after six months of treatment was 13.1% (partial response 4, minor response 4). Two complete responses were obtained at nine and fifteen months (3.3%). Long-lasting stabilization of disease was 13.1 percent.
Screening mammography. Screening mammography can reduce mortality from breast cancer and is the only means of detecting nonpalpable cancers that are often more curable. Based on this, guidelines have evolved but compliance with them has been slow. Reservations are based on yield-cost-benefit-harm considerations, but uniformed and/or disadvantaged women and reluctance if not resistance to screening mammography by primary care physicians are major problems. The challenges are to overcome these obstacles and to obtain sufficient competent personnel and facilities to make reproducibly optimum screening mammography, which is accurately interpreted, widely available to all eligible women at the lowest possible cost.
Colposcopic evaluation of human immunodeficiency virus-seropositive women. To determine the effect of human immunodeficiency virus (HIV) infection on cervical histology, 32 known HIV-seropositive women underwent cervical colposcopic evaluation. All had cervical cytology, colposcopically directed biopsy, and T-cell studies performed. Thirteen of 32 patients (41%) had cervical intraepithelial neoplasia (CIN). Another 14 of 32 patients (44%) had histologic evidence of cervicitis. Abnormal cytology, noted in only three women, suggested CIN in one and inflammatory atypia in two. All (five of five) patients with a clinical diagnosis of AIDS had CIN, compared with 30% (eight of 27) of non-AIDS HIV-positive patients (P less than .05). Patients diagnosed with CIN had significantly lower CD4 cell counts (221/mm3 versus 408/mm3; P less than .06) and CD4:CD8 ratios (0.33 versus 0.62; P less than .02) than those without CIN. Patients with cervicitis had greater T-cell immunosuppression than did those with normal histology. In addition, patients with AIDS were more likely to have higher-grade lesions than were non-AIDS HIV-seropositive patients. Seven of 12 CIN specimens available for analysis by polymerase chain reaction using consensus sequence primers detected human papillomavirus (HPV) DNA, including three patients with three or more HPV types. Our data suggest that abnormal cervical pathology is common among HIV-positive women and that cytologic screening is not predictive of CIN in this population. In addition, the presence and severity of cervical dysplasia correlates with quantitative T-cell function. We strongly recommend that cervical colposcopy be part of the routine management of HIV-seropositive women.