shukoor65/lab-rag-model huggingface dataset:
Sarcoma in Paget disease of bone: clinical, radiologic, and pathologic features in 22 cases. The clinical, radiologic, and histologic features of 22 cases of Paget sarcoma were reviewed to determine in which patients with Paget disease these tumors are most likely to develop and what radiologic findings suggest the diagnosis. Clinical findings at presentation included pain and/or a mass (11 patients), pathologic fracture (seven), and neurologic symptoms (four). Survival time in 20 patients ranged from 5 days to 2.5 years. Two patients were lost to follow-up: one at 2 years and one at 8 years. There were 16 high-grade osteosarcomas, three chondrosarcomas, two fibrosarcomas, and one malignant fibrous histiocytoma. The most common site was the femur. Tumors also were observed in unusual sites. In one case of multifocal osteosarcoma, the tumor involved only pagetic bone. In 15 patients, Paget disease was polyostotic, clinically significant, and had been documented previously. In four patients, a sarcoma developed near the site of a fracture that had occurred between 2 months and 15 years previously. All cases showed radiologic evidence of a destructive lesion; other findings included a mass and evidence of tumor mineralization. Periosteal reaction was not observed. All but one tumor developed in a site of osteoblastic or mixed osteoblastic and lytic Paget disease. Our results suggest that sarcomas can develop in any part of any bone affected by Paget disease but are more likely to occur with advanced disease and to present with a destructive lesion without periosteal reaction.
Determination of the c-MYC DNA-binding site. The carboxyl terminus of the protein encoded by the c-MYC protooncogene has similarity to the helix-loop-helix family of DNA-binding proteins and recognizes a six-nucleotide-long DNA sequence. We have used in vitro-translated c-MYC protein to further define its DNA-binding specificity. The hexanucleotide originally identified is necessary for DNA binding by c-MYC, but not sufficient; the c-MYC target site is a 12-nucleotide-long palindrome. This site is present within regulatory regions of genes that are expressed during cell growth. Point mutations within the helix-loop-helix motif of c-MYC abolish DNA-binding and transforming activities, indicating that c-MYC acts as a DNA-binding protein to transform cells. c-MYC may transform cells by activating transcription of genes required for cell division.
Clinical and inflammatory responses to exogenous tachykinins in allergic rhinitis. Our purpose was to characterize the tachykinin receptor type involved in nasal obstruction to exogenous substance P in rhinitic patients. We also attempted to assess biochemical and cellular events associated with this response. Nasal challenges were performed in seven patients with allergic rhinitis. They received increasing doses (10 to 80 nmol) of substance P, of neurokinin A, of the N-terminal fragment of substance P, substance P(1-9), and of saline on 4 different days separated by 14 days. Nasal airway resistance (NAR) increased in a dose-dependent manner on substance P. Maximal increase reached 4.5-fold basal NAR. Response to neurokinin A was significantly lower (less than 2-fold basal NAR). No effect was observed on substance P(1-9) and saline. This order of activity [substance P much greater than neurokinin A greater than substance P(1-9) = saline] indicates an NK1 receptor-mediated mechanism inducing local vasodilation. No histamine release was found after any of the four challenges. Proteins significantly increased in nasal lavage fluid on both substance P and neurokinin A, whereas substance P(1-9) and saline had no effect. The percentage of albumin increased in nasal lavage fluid from 30 to 50% of total proteins on substance P and neurokinin A, indicating microvascular leakage. Polymorphonuclear cells significantly increased from 9 to 36% on substance P, from 13 to 49% on neurokinin A, and from 13 to 55% on substance P(1-9). Eosinophils increased in five patients on substance P (from 0.1 to 5% for the group), in three patients after neurokinin A, and in two after substance P(1-9).
Excessive sweating: an uncommon sign of basilar artery occlusion. Excessive sweating of the face and, to a lesser degree, of the thorax and limbs, occurred after basilar artery occlusion in a 15 year old Saudi boy. Magnetic resonance imaging (MRI) showed a limited bilateral paramedian infarction of the rostral ventral pons. Basilar artery occlusion in children and adolescents is a rarity. Excessive sweating following such a stroke is rare in any age group. Clinico-anatomical correlations are discussed.
Schwannoma of the brachial plexus mimicking an apical lung tumor. Primary tumors of the brachial plexus are unusual. We describe a patient with a large schwannoma of the lower trunk of the brachial plexus that had the radiologic appearance of an apical lung mass. Use of a posterior subscapular approach as well as intraoperative nerve action potential recording permitted resection with spared function.
Pediatric approach to the diagnosis and management of otitis media. The diagnosis of otitis media is complicated by confusing terminology and a disease continuum with overlap between clinical entities. The patient's history often reveals determinants of otitis media chronicity and recurrence. Certain laboratory tests, including tympanocentesis for middle ear fluid culture, may be useful in treatment decisions. Although seven antimicrobial drugs are useful in treating acute otitis media, certain drugs are more useful in specific cases. There are several medical treatment options for chronic otitis media with effusion and for preventing recurrent acute otitis media.
Prognostic implications of the localization of carcinoma in the head of the pancreas. Between 1974 and 1989, 411 patients with pathologically and anatomically proven carcinoma of the head of the pancreas underwent endoscopic retrograde cholangiopancreatography (ERCP). According to the localization of the tumor, these patients were divided into those with a cranially, centrally (periductally), caudally, or indeterminately localized tumor. In cranially localized tumors, extrahepatic metastases and vessel invasion were absent or resectable in 53% and 46%, respectively. The tumor was resectable in 41% of cases. If a patient with a cranially localized tumor could not be operated curatively for secondary reasons, the prognosis was better than for tumors with another localization. If there was unresectable vessel invasion and the tumor was not resectable, the 0% survival rate was reached at 33 months. Of the curatively operated patients, 26% were alive at 36 months after the start of complaints. Of the centrally or periductally localized tumors, there were no liver metastases in 73%. Extrahepatic metastases and vessel invasion were absent or resectable in 57% and 53%, respectively. The tumor was resectable in 48% of cases. If there was unresectable vessel invasion or the tumor was unresectable, the 0% survival rate was reached after 18 months. These tumors have maximal chances at curative resection. Of the curatively operated patients, 31% were alive at 36 months after the start of complaints. In caudally localized tumors, there were liver metastases in 59%, unresectable other abdominal metastases in 93%, unresectable vessel invasion in 91%, and the tumor was unresectable in 96%. In patients with an unresectable vessel invasion or an unresectable tumor, the 0% survival rate was reached after 33 months; 3% of these patients were operated curatively. Indeterminately localized tumors had liver metastases in 77%, unresectable extrahepatic metastases in 90%, unresectable vessel invasion in 95%, and the tumor was unresectable in 91%. Only one of the 44 patients (2%) could be operated curatively.
Determinants of 2-year outcome after coronary angioplasty in patients with multivessel disease on the basis of comprehensive preprocedural evaluation. Implications for patient selection. The Multivessel Angioplasty Prognosis Study Group. BACKGROUND. To assess the likelihood of intermediate-term event-free survival (freedom from death, coronary artery bypass surgery, and myocardial infarction) in patients with multivessel coronary disease undergoing coronary angioplasty, 350 consecutive patients from four clinical sites were carefully evaluated and followed for 22 +/- 10 months. METHODS AND RESULTS. Eight clinical variables were evaluated at the clinical sites, and 23 angiographic variables describing the number, morphology, and topography of coronary stenoses were evaluated at a core angiographic laboratory. Most patients had Canadian Cardiovascular Society class III or IV angina (72%), two-vessel coronary disease (68%), and well-preserved left ventricular function (mean ejection fraction, 58 +/- 12%; range, 18-85%). Follow-up was complete in 99% of patients. At 2 years, event-free survival was 72%, overall survival was 96%, freedom from bypass surgery was 82%, and freedom from nonfatal myocardial infarction without surgery was 96%. Sequential Cox proportional hazards regression analyses allowing stepwise entry of variables prospectively coded as simple, as of intermediate complexity, or as complex found event-free survival to be independently predicted by low Canadian Cardiovascular Society angina class, no diabetes, no proximal left anterior descending stenoses, and the sum of stenosis simplified risk-territory scores of 15 or less. In the absence of class IV angina and these risk factors, 2-year event-free survival was 87% and overall survival was 100%. In the presence of two or more of these risk factors, event-free survival was less than 50%. CONCLUSIONS. Recognition of risk factors for poor long-term outcome in this setting may improve clinical decision making and provide a framework on which to base meaningful subgroup analyses in randomized trials assessing the efficacy of coronary angioplasty.
Effects of allergy and age on responses to salbutamol and ipratropium bromide in moderate asthma and chronic bronchitis. The bronchodilating responses to 400 micrograms salbutamol and 80 micrograms ipratropium bromide were studied in 188 patients with chronic bronchitis (n = 113) or asthma (n = 75) and mild to moderate airflow obstruction (forced expiratory volume in one second (FEV1) above 50% but below 2 SD of predicted value) in a crossover study on two days a week apart. Both the patients with asthma and the patients with chronic bronchitis varied considerably in their responses to the salbutamol and the ipratropium bromide. The mean increase in FEV1 in the subjects with asthma was higher after salbutamol (0.371 or 18% of the prebronchodilator value) than after ipratropium bromide (0.26 1 or 13%). In chronic bronchitis there was no difference between the increase in FEV1 after salbutamol (0.161 or 7%) and after ipratropium bromide (0.191 or 8%). When patients were categorised into those with a better response to salbutamol 400 micrograms and those with a better response to ipratropium bromide 80 micrograms, patients with chronic bronchitis responded better in general to ipratropium bromide whereas asthmatic patients responded better to salbutamol. The response pattern was also related to allergy and age, allergic patients and patients under 60 being more likely to respond better to salbutamol 400 micrograms than non-allergic patients and older patients, who benefited more from ipratropium bromide 80 micrograms. The response pattern was not related to sex, smoking habits, lung function, bronchial reactivity, respiratory symptoms, or number of exacerbations during the preceding year.
Cinematics and sticking of heart valves in pulsatile flow test. The aim of the project was to develop laboratory test devices for studies of the cinematics and sticking behaviour of technical valve protheses. The second step includes testing technical valves of different types and sizes under static and dynamic conditions. A force-deflection balance was developed in order to load valve rims by static radial forces until sticking or loss of a disc (sticking- and clamping-mould point) with computer-controlled force deflection curves. A second deflection device was developed and used for prosthetic valves in the aortic position of a pulsatile mock circulation loop with simultaneous video-cinematography. The stiffness of technical valve rims varied between 0.20 (St. Jude) and about 1.0 N/micron (metal rim valves). The stiffness decreased significantly with increasing valve size. Sticking under pulsatile flow conditions was in good agreement with the static deflection measurements. Hence, valve sticking with increasing danger of thrombus formation is more likely with a less stiff valve rim. In the case of forces acting perpendicularly to the pendulum axis, the clamping mould-point of the valve can be reached, followed by disc dislodgement.
5-lipoxygenase inhibitory activity of zileuton. Zileuton [N-(1-benzo[b]thien-2-ylethyl)-N-hydroxyure] inhibited 5-hydroxyeicosatetraenoic acid synthesis by rat basophilic leukemia cell 20,000 x g supernatant and rat polymorphonuclear leukocytes (PMNL) (IC50 = 0.5 and 0.3 microM) respectively. It also inhibited leukotriene (LT)B4 biosynthesis by rat PMNL (IC50 = 0.4 microM), human PMNL (IC50 = 0.4 microM) and human whole blood (IC50 = 0.9 microM). Inhibition of human PMNL LTB4 biosynthesis was removed readily by a simple wash procedure. At concentrations up to 100 microM, the compound produced little or no inhibition of several related enzymes, such as platelet 12-lipoxygenase, soybean and rabbit reticulocyte 15-lipoxygenase and sheep seminal vesicle cyclooxygenase. At p.o. doses from 0.5 to 5 mg/kg in the dog, zileuton produced a rapid and sustained inhibition of ex vivo blood LTB4 biosynthesis which correlated with the pharmacokinetic behavior of the compound. In a similar ex vivo study in the rat, the compound displayed an p.o. ED50 of 2 mg/kg. Zileuton was highly effective in preventing 6-sulfidopeptide LT formation in the rat peritoneal cavity triggered by an antigen-antibody reaction with an ED50 of 3 mg/kg. In experimental models of inflammation, zileuton significantly reduced arachidonic-acid induced mouse ear edema (ED50 = 31 mg/kg) and also attenuated inflammatory cell accumulation in the rat pleural Arthus reaction. The effectiveness of this compound for preventing LT formation in vitro, ex vivo and in vivo suggests its utility for preventing the pathophysiological effects of the LTs and other 5-lipoxygenase products in animals and in humans.
Thyroid cancer and multiple primary malignancies in Israel. The exact risk of multiple primary neoplasms in patients with thyroid cancer is difficult to ascertain from the data available in the literature. Three thousand seventy-two patients with thyroid cancer, listed in the Israel Cancer Registry during a 16-year time span, were studied to determine the true incidence of another primary cancer. Ninety-two cases were reported as having an additional primary cancer. The prevalence of multiple primary malignancies was 3%. The frequency was higher among patients of European rather than of Asian or African origin. The second primary cancers in order of decreasing frequency were of the breast, lung, colorectum, head and neck, and lymphoma/myeloma. Most of the deaths were due to the additional cancer. The 5-year survival rate was highest for head and neck and lowest for lung cancer patients. These results emphasize the need for greater awareness of the possibility of developing additional cancers, and indicate the need to incorporate strategies for the prevention, early detection, and treatment of multiple primary neoplasms.
Active HSV-1 immunization prevents the cocarcinogenic activity of HSV-1 in the oral cavity of hamsters. Previous investigations have demonstrated that herpes simplex virus (HSV) increased the oral carcinogenic activity of 7,12-dimethylbenz[a]anthracene (DMBA) probably by enhancing the DMBA-induced amplification and overexpression of c-erb-B-1 proto-oncogene in hamster buccal pouch epithelium. The present study investigated the effect of active type 1 HSV (HSV-1) immunization on the development of oral cancer induced by HSV-1 and DMBA, alone or in combination, in the hamster buccal pouch. The results were similar to our previous report in that HSV-1 significantly enhanced the oncogenic effect of DMBA, and the numbers of pouches harboring tumor nodules and the numbers and sizes of tumors developed by topical DMBA were significantly increased by HSV-1 inoculation to the site of the DMBA application. Although HSV-1 immunization did not alter the carcinogenic activity of DMBA in animals receiving topical DMBA in combination with mock inoculation, it prevented the cocarcinogenic effect of HSV-1 in animals receiving topical DMBA in conjunction with HSV-1 inoculation. These data indicate that active HSV-1 immunization completely obstructs the co-oncogenic effect of HSV-1 in the oral cavity of hamsters.
Neurologically normal patients with suspected postpoliomyelitis syndrome: electromyographic assessment of past denervation. Patients with neurologic signs consistent with previous poliomyelitis have been shown to have electrodiagnostic evidence of widespread denervation, often in clinically normal muscles thought to have been uninvolved by poliomyelitis. Eight percent of patients seen in our postpoliomyelitis clinic had no abnormalities on neurologic examination or with conventional electrodiagnostic studies to corroborate history of poliomyelitis. Seventeen patients were studied, subtle electrodiagnostic evidence of denervation was sought. Measurements of fiber density and analysis of turns and amplitude showed no abnormalities in nine patients. Five patients had borderline elevated fiber density. Analysis of turns and amplitude showed mild neurogenic changes in two patients and borderline changes in three patients. These findings were disparate, with isolated abnormalities in individual muscles. It was concluded that (1) there is a group of patients whose histories of poliomyelitis are uncertain, and (2) the lack of clear evidence for previous denervation after extensive electrodiagnostic testing is a valid means for excluding the diagnosis of postpoliomyelitis syndrome.
Complications of bladder neck suspension procedures. Typical genuine stress urinary incontinence is the result of an anatomic defect, with most procedures designed to restore the support of the proximal urethra and bladder neck. Complications associated with these procedures have been presented to help facilitate an understanding of their etiology and prevention. Careful attention to patient selection, history and physical examination, and surgical detail can prevent most of these complications.
Deep venous thrombosis in the surgical intensive care unit. The ICU patient population is at a high risk for the development of deep venous thrombosis leading to a potentially fatal pulmonary embolism. It is vital to appreciate this risk and apply appropriate prophylaxis. Constant vigilance is required, as deep venous thrombosis and pulmonary emboli can develop and progress despite standard prophylactic measures. In unstable patients, more aggressive prophylaxis may be warranted, including the use of inferior vena cava filters. A high index of suspicion and a low threshold for screening and diagnostic testing will allow earlier recognition and treatment of this lifethreatening condition. Treatment decisions are based on clinical suspicion, diagnostic examination results, and the potential complications of difficult treatment modalities.
Aortitis caused by Mycobacterium fortuitum. Aortic valve replacement was complicated by sternal wound infection with Mycobacterium fortuitum. The wound was treated with debridement and antibiotic therapy. Five months later the patient developed fever, and blood cultures yielded M fortuitum. At surgery, aortitis with pseudo-aneurysm formation was encountered. Mycobacterium fortuitum grew from the aortic lesion. This is the first report of M fortuitum causing aortitis, although this organism is known to infect sternal wounds and mediastinum. Mediastinal infection can progress despite a normal wound appearance. Its manifestations may be delayed and may include infections of the aorta as well as of the sternum and mediastinum.
Acute exacerbation of bronchial asthma in children associated with afternoon weather changes. We studied the effect of the weather on acute exacerbations of bronchial asthma in children by comparing records of 8,657 admissions for five acute respiratory diseases (3,064 for asthma) with concurrent meteorologic data. These diseases were classified according to their interrelations and distinct meteorologic patterns into two groups: (1) acute asthma and acute laryngitis, which are correlated with the afternoon gradients of air temperature, heat content (the thermal energy of the ambient air), and modified heat content factor (the energy required to heat the air water vapor to the ambient temperature), but not correlated with the absolute values of air temperature and water content: and (2), bronchopneumonia/pneumonia and upper respiratory infections, which are correlated only with the absolute values of the meteorologic parameters (air temperature, water content, heat content, and modified heat content factor), but not with their afternoon gradients. Admissions for bronchiolitis revealed an age-related pattern: up to 1 yr they resembled Group 2 and from 1 to 2 yr, Group 1. It follows that the admission rates of acute exacerbation of bronchial asthma in childhood are linked both to the afternoon weather gradients and to some of the acute respiratory infections.
Magnetic resonance imaging of central nervous system lesions in patients with lupus erythematosus. Correlation with clinical remission and antineurofilament and anticardiolipin antibody titers. Clinical, magnetic resonance imaging (MRI), and serologic studies were performed on 11 patients with diffuse central nervous system (CNS) systemic lupus erythematosus and 8 patients with focal CNS lupus. MRI of patients with diffuse clinical disease showed symmetrically distributed areas of increased signal intensity in the subcortical white matter; these resolved after treatment with high-dose methylprednisolone. These patients' sera contained elevated levels of antineurofilament antibodies. Patients with focal CNS lupus had areas of increased signal intensity and atrophic changes in regions corresponding to the major cerebral vessels. These MRI abnormalities did not improve after treatment with high-dose steroids. The sera of patients with focal CNS lupus had elevated levels of cardiolipin and lupus anticoagulant but normal levels of antineurofilament antibody. Our findings suggest that results of a combined clinical, MRI, and serologic evaluation of patients with CNS lupus may predict the response of patients to high-dose steroid therapy.
Endemic giardiasis and municipal water supply. To test the hypothesis that endemic giardiasis may be transmitted by unfiltered municipal water supplies, the incidence of laboratory-confirmed giardiasis was studied in a natural experiment due to the arrangement of the public water supply of Dunedin, New Zealand. The incidence rate ratio was 3.3 (90% CI = 1.1, 10.1) for the population receiving unfiltered (microstrained) water relative to that using sand filtered water. In a parallel case-control study of incident cases, the odds ratio for giardiasis and unfiltered (microstrained) water supply was 1.8 (90% CI = 0.5, 6.9).