shukoor65/lab-rag-model huggingface dataset:
Role of intraoperative ultrasound examination in patients undergoing a Fontan-type procedure. To determine its potential impact on perioperative surgical management intraoperative ultrasound examination (cross sectional imaging, colour flow mapping, pulsed and continuous wave Doppler) was used in 16 consecutive patients undergoing a Fontan-type procedure. Epicardial cross sectional imaging before bypass defined the precise intracardiac morphology in 15 of 16 patients. The preoperative morphological diagnosis was refined in four patients (25%), and this influenced surgical management in two (12%). Epicardial studies after bypass identified seven residual haemodynamic lesions in five patients (three residual intercardiac shunts, one ventricular outflow obstruction, one pulmonary artery obstruction, two mitral valve regurgitation), and led to immediate revision during a second period of bypass in three (18%). In one patient who required early reoperation residual shunting was not detected after bypass by either colour flow mapping or a contrast study. Final intraoperative studies showed a good surgical result in 14 patients (87%). Flow characteristics and flow velocities within the Fontan circulation could be assessed immediately after the patient came off cardiopulmonary bypass by means of combined pulsed wave Doppler and colour flow mapping in 14 of the 16 patients. Cross sectional studies of the left heart after bypass showed no change in ventricular function and allowed monitoring of volume replacement and ventricular filling. Intraoperative ultrasound was a valuable monitoring technique in patients undergoing a Fontan-type procedure. It refined preoperative diagnosis, monitored ventricular function, and identified or excluded residual haemodynamic lesions in most patients.
Primary cutaneous gamma/delta T-cell lymphoma presenting as disseminated pagetoid reticulosis. The first case of primary gamma/delta cutaneous T-cell lymphoma (CTCL) with a fatal outcome is reported. The patient had the clinical and histopathologic features of disseminated pagetoid reticulosis, a rare form of CTCL characterized by a strong epidermotropic lymphoid infiltrate. Extensive immuno-cytochemical studies showed that the neoplastic cells were almost exclusively localized in the epidermis, expressed the gamma/delta variant of the T-cell receptor (CD3+, TCR-delta-1+) and were CD5+, CD7+, CD27+, CD29+, CD43+, CD44+, CD45+, CD45RA+, CD54+, CD69+, but beta F1-, Ti gamma a-, BB3-, A13-, CD2-, CD4-, CD8-, CD11a-, CD49d-, CD25-, CD30-, and HLA-DR-. A comparison of our results with those of the literature, which have not included gamma/delta T-cell receptor analysis, suggests that some reported cases of pagetoid reticulosis may have phenotypes similar to our case. Electron microscopy studies demonstrated that the gamma/delta T lymphocytes were villous, containing dense and multivesicular bodies, and formed close contacts with the surrounding keratinocytes, suggesting that these cells should have a role in the skin-associated lymphoid tissue. The proliferating cells in our case might represent the neoplastic counterpart of the recently reported CD2- subset of normal human peripheral blood gamma/delta T lymphocytes.
Efficacy of (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine in various models of herpes simplex virus infection in mice. The phosphonylmethoxyalkyl derivative (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine (HPMPC) was evaluated for its in vivo efficacy in several model infections for herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) and thymidine kinase-deficient (TK-) HSV-1 in mice. In hairless mice infected intracutaneously with HSV-1 or HSV-2, HPMPC completely suppressed all manifestations of the disease (skin lesions, paralysis of the hind legs, and mortality) if it was administered topically at a concentration of as low as 0.1, 0.3, or 1%. Similarly, HPMPC completely suppressed TK- HSV-1 infection in athymic nude mice if it was administered topically at 0.1 or 0.3% or intraperitoneally at 100 or 250 mg/kg/day. HPMPC was also effective against intraperitoneal HSV infection if it was given orally at a dose of 50 mg/kg/day or higher. In mice inoculated intracerebrally with HSV-2, intraperitoneal HPMPC treatment achieved a significant and dose-dependent protection at doses ranging from 5 to 400 mg/kg/day. The protective effect of HPMPC (at 200 mg/kg/day) was accompanied by a complete inhibition of virus multiplication in the brain. In all models of infections studied, the efficacy of HPMPC proved to be superior to that of acyclovir. The most remarkable feature of HPMPC was that a single administration of the compound, even as late as 4 days after infection, conferred significant protection against HSV-1 or HSV-2 infection. Topical or systemic HPMPC treatment is efficacious in murine models of HSV-1, HSV-2, and TK- HSV infections.
Use of life-sustaining care for the elderly. Advanced age has been proposed as one criterion for limiting the use of life-sustaining medical treatment, but very little is known about current practices. We retrospectively studied utilization rates of intensive care (IC) and cardiopulmonary resuscitation (CPR) in admissions to a university hospital over 1 year (n = 9,998), to test whether these treatments are used more selectively for elderly patients. Overall utilization rates did not vary by age. However, among 524 terminal admissions, IC was used for 63% of patients age 35-74 but for only 50% of patients 75 and older (P less than 0.01). Among elderly patients, nursing home residence, diagnosis of advanced malignancy, severe chronic illness, and older age were independent predictors of withholding IC prior to death. Despite more selective use, survival rates were lower for elderly than for younger patients receiving IC (88% vs 78%, P less than 0.001). CPR showed similar but non-significant trends. Intensive care is being used less frequently prior to death for elderly patients, based on diagnosis and functional status as well as chronologic age.
Paediatric blood pressure and anaesthesia. One percent of children have appreciably and consistently raised arterial blood pressure. A 7-year-old girl admitted for routine tonsillectomy, had unrecognised hypertension which put her at increased risk. Should anaesthetic practice take more note of paediatric blood pressures?.
Changes in body composition and energy expenditure after six weeks' growth hormone treatment. Changes in body composition and energy expenditure were assessed in 15 children after six weeks of human growth hormone (hGH) treatment. Body composition measurements were made by stable isotope labelled water (H2(18)O) dilution, bioelectrical impedance, and skinfold thickness techniques. Energy expenditure was assessed both by indirect ventilated hood calorimetry (resting energy expenditure) and the stable isotope doubly labelled water (2H2(18)O) technique (free living daily total energy expenditure). Mean increases in weight of 0.96 kg and fat free mass of 1.37 kg and a mean decrease in fat mass of 0.41 kg were observed. Significant increases both in resting energy expenditure and free living daily energy expenditure were detected. Absolute changes in fat mass and resting energy expenditure were correlated. The data suggest (i) that the increase in the fat free mass is the most significant early clinical measure of hGH response and (ii) that hGH increases the metabolic activity of the fat free mass. Monitoring such changes may be predictive of the efficacy of hGH in promoting growth.
Gastric leiomyosarcoma. Prognostic factors and surgical management. Information on gastric leiomyosarcoma, such as important prognostic factors, patterns of disease recurrence, and optimal methods of treatment, are derived from limited patient experience. We address these questions, with specific focus on whether an advantage could be demonstrated for radical resection compared with wide local excision, by retrospectively investigating 53 patients who underwent surgical treatment at Mayo Clinic, Rochester, Minn. Abdominal pain and/or gastrointestinal bleeding associated with an intramural or exogastric mass were typical features of this disease. Only tumor size and histologic grade were statistically significant prognostic factors. With analysis of survival curves and patterns of recurrence, neither the addition of lymphadenectomy nor the wider tumor-free margins of a radical gastrectomy seemed superior to the more conservative local excision. Therefore, wide local excision remains the preferred treatment when technically feasible.
Alpha-thalassemia resulting from deletion of regulatory sequences far upstream of the alpha-globin structural genes. We describe an alpha-thalassemia determinant in which alpha-globin expression is silenced by a deletion located 27 kb 5' to the transcription start site of the alpha 2-globin gene. This alpha-thalassemic determinant, (alpha alpha)MM, is a member of a newly described group of thalassemic mutations resulting from deletion of locus-controlling sequences critical to globin gene expression.
Technetium-99m-d,1-hexamethylpropyleneamine oxime (HMPAO) uptake and glutathione content in brain tumors Technetium-d, HMPAO SPECT was performed in 70 patients suffering from intracerebral tumors of various histologic types (glioma n = 30, meningioma n = 19, metastases n = 10, angioma n = 3, neuroma n = 2, lymphoma n = 2, neurocytoma n = 1, epidermoid n = 1, gliosis n = 1, cholesteatoma n = 1). Tumor classification was histologically verified in all subjects except in two cases with inoperable angiomas. SPECT was performed under resting state conditions with a dual-head rotating camera (SIEMENS ZLC 37) following intravenous injection of 18-25 mCi 99mTc-d, 1-HMPAO. Regional tracer deposit was expressed in terms of a cerebellar index (CBI). Significantly higher regional HMPAO uptake was found in meningiomas when compared with gliomas of different malignancy (ANOVA p less than 0.05). Within gliomas, regional uptake increased with malignancy (n.s.). In 23 patients, a total of 32 tumor specimens were obtained for histochemical analysis of glutathione (GSH) content using high-pressure liquid chromatography. A significant correlation (least square method, p less than 0.001) between CBIs and GSH values was found, supporting the hypothesis that GSH is the predominant factor for the conversion of the lipophilic complex to hydrophilic derivates.
Doxapram after general anaesthesia. Its role in stopping shivering during recovery. A group of patients who developed postoperative shivering after receiving inhalational anaesthesia were assigned, at random, to receive either doxapram or a placebo under double-blind conditions. A significantly higher proportion of patients stopped shivering after being given doxapram than after the placebo.
A technique for control of hypertrophic scarring in the central region of the face. Various methods are available for applying pressure to the central portion of the face to reduce hypertrophic scarring after burn injury. Our center uses an elastomer insert with a thermoplastic backing, which is formed over a plaster mold of the patient's face. The insert is worn under a traditional anti-burn scar face mask. We reviewed the records of 26 patients with hypertrophic scarring to the central portion of the face to assess the effectiveness of the insert. Seventeen (65%) of these patients wore the insert until scar maturation. Three of these 17 patients later required reconstructive surgery of the central face. Our findings suggest that pressure to this part of the face may be effective in decreasing hypertrophic scar formation. The insert described in this article is inexpensive and relatively easy to fabricate.
Normal thymus simulating pericardial disease: diagnostic value of magnetic resonance imaging. Normal enlargement of the thymus in infancy can often lead to erroneous clinical suspicion of cardiomegaly. Roentgenographic differentiation is not always definitive but echocardiography is generally effective in differentiating cardiac pathology from an enlarged thymus. In this patient, magnetic resonance imaging was necessary to differentiate benign thymic hyperplasia from pericardial or mediastinal pathology. Thymic involution with a severe neonatal illness, followed by thymic rebound, which later subsided, added to the interest and initial confusion in this patient.
Transseptal catheterization in adults: enhanced efficacy and safety by low-volume operators using a "non-standard" technique. Transseptal catheterization is often not performed because of concerns about morbidity and mortality. The authors present several refinements of this technique that have allowed a series of cases to be done with minimal morbidity or mortality. This was possible despite limited previous experience in this technique and a relatively low-volume of cases.
Association between disturbances in the immune system and hypertension. For many decades evidence has been accumulating which implicates the immune system in the etiology and pathogenesis of hypertension. There appears to be a strong association between hypertension and immunologic dysfunction in humans and in rats. Patients with severe hypertension have significantly higher levels of serum IgG in comparison with normotensive controls. A positive correlation has been found between serum IgG levels and blood pressure in untreated essential hypertensive patients. In some studies it has been demonstrated that autoantibody levels are higher in both untreated and treated hypertensive patients than in normotensive control subjects. Furthermore, in the spontaneously hypertensive rat (SHR), several indices of immune system function have been shown to be depressed. There is also a significant correlation between immune intervention and antihypertensive effects. Short term administration of anti-rat thymocyte serum results in a significant decrease in the arterial pressure of the SHR. Chronic cyclophosphamide treatment prevents the progression of hypertension and significantly reduces its final level in the adult SHR. Neonatal thymic implants from normotensive donor rats delay the development of hypertension and significantly attenuate the level of the hypertensive state in the SHR. Also, thymectomy at an age of 4 weeks delays the development of hypertension in the SHR. The differences in the antihypertensive effectiveness of a variety of immunological manipulations in the SHR may be the result of their different levels of improvement on the severity of the autoimmune process in these rats.
Klebsiella pneumoniae urinary tract infection complicated by endophthalmitis, perinephric abscess, and ecthyma gangrenosum. We have reported the case of an immunocompromised patient with a K pneumoniae bacteremia admitted with endophthalmitis. The source of the infection was an asymptomatic left renal calculus associated with a perinephric abscess. Persistent bacteremia resulted in the development of ecthyma gangrenosum, which has not previously been associated with Klebsiella spp infection.
DEGR-factor Xa blocks disseminated intravascular coagulation initiated by Escherichia coli without preventing shock or organ damage. One of the aims of research in the area of thrombosis has been to design an effective anticoagulant that would function in a predictable and direct manner. In evaluating the role of coagulation in sepsis we used factor Xa blocked in the active center with [5-(dimethylamino)1-naphthalenesulfonyl]-glutamylglycylarginyl+ ++ chloromethyl ketone (DEGR-Xa). We infused 1 mg/kg of DEGR-Xa together with LD100 concentrations of Escherichia coli (4 x 10(10) organisms/kg) into five baboons. As controls, we infused E coli alone into five baboons. The inflammatory, coagulant, and cell injury responses to E coli of both the treated and control groups were lethal and were similar in every respect except for the complete inhibition of the consumption of fibrinogen in the DEGR-Xa group. The half life of DEGR-Xa was approximately 10 hours and 2 hours, as determined by isotopic and enzyme-linked immunosorbent assays, respectively. These results for the first time demonstrate that, although coagulation occurs in E coli sepsis, fibrin formation per se did not influence the lethal outcome in this model. These results also show the effectiveness of DEGR-Xa as an anticoagulant and raise the possibility that it could serve as an alternative to anticoagulants currently in use.
Symptomatic pancreatic heterotopia treated by local excision. Non-ulcer dyspepsia is a continuing problem and in many cases a precise cause is never identified. We present five patients with an allegedly uncommon condition--pancreatic heterotopia. They were managed by local excision of the tumour and after a mean (range) follow up of 42 (9-80) months all remain free of the original symptoms.
Influence of parenteral nutrition on leg nitrogen exchange in injured patients. Body N balance, 3-methylhistidine (MEH) excretion, amino acid (AA) plasma concentration, and fluxes across the leg were investigated both during fasting and during parenteral nutrition of injured patients in order to better understand protein-sparing mechanisms induced by metabolic support in the whole body and in skeletal muscle. Patients were randomized to receive 15 or 30 kcal/kg.day coupled with 0.30 g of N either with standard or branch-chain (BC)-enriched AA solutions. During fasting, patients were highly catabolic (N balance -14.7 +/- 1.2 g N/m2.day, MEH excretion 422 +/- 25 mumol/m2.day) and showed a high efflux of AA N from the leg (5.08 +/- 2.1 g N/m2.day) without difference between the groups. During treatment, body N balance (-5.55 +/- 0.88, p less than .001) and MEH excretion (284 +/- 20, p less than .001) were significantly reduced without difference among the groups; also, AA N leg efflux (2.64 +/- 0.47, p less than .001) was reduced. Moreover, considering the effect of calorie load, patients receiving 30 kcal/kg.day showed a lower efflux of total AA N and of some AA considered as markers of muscle protein catabolism, such as phe, lys, met, and glu. The main difference between solutions was in the efflux of BCAA; particularly, val and leu efflux was turned into uptake in the BCAA group. No significant difference among the groups was found in N balance and MEH excretion during treatment. In brief, muscle catabolism was reduced in an amount dependent on glucose and insulin load, but it was not influenced by BCAA supply. Whole body net protein catabolism was reduced through different mechanisms, either an increased visceral N retention or a decreased muscle N loss. However, muscle N loss was never abolished even in the high calorie groups.
Magnetic resonance imaging of temporomandibular joint after surgical treatment of internal derangement. Sagittal and coronal surface coil magnetic resonance imaging was performed on 21 patients who about 2 years earlier had surgery for temporomandibular joint internal derangement. Surgical procedure included disk repositioning (23 joints) and diskectomy (seven joints). At the time of reimaging, 20 joints showed recurrence of pain and 10 joints were asymptomatic. Extensive fibrous tissue was seen in the joint space and in the joint capsule in 13 of the 20 painful joints, whereas minimal fibrous tissue in the lateral capsule wall was seen in 3 of the 10 nonpainful joints. Fibrous tissue was surgically confirmed in 10 of the painful joints. Disk displacement was seen in 11 of the 23 joints that had surgical disk repositioning. Disk displacement was seen in both painful (9/17) and nonpainful joints (2/6). It was concluded that magnetic resonance imaging is an excellent method for postoperative imaging of the temporomandibular joint and that attention should be directed to the presence or absence and extension of the fibrous tissue in the joint space and in the joint capsule.
Post-laryngectomy stomal recurrence: tumour implantation or paratracheal lymphatic metastasis? In the treatment of obstructing laryngeal cancer, an association has often been noted between emergency tracheotomy for airway relief and subsequent post-laryngectomy stomal recurrence. It is however unclear whether this is due to tumour implantation in the tracheotomy track, or paratracheal lymph node metastasis. To investigate the pathophysiology of stomal recurrence, the recurrence rate and clinical outcome of 26 cases of T3N0M0 glottic cancer treated with emergency tracheotomy and subsequent laryngectomy were analysed, and compared with 65 stage-matched cases treated with laryngectomy alone. Analysis shows the 'emergency tracheotomy' group to have a very poor prognosis with a higher incidence of recurrence at the stoma, and also in the regional lymph nodes. These findings suggest that paratracheal lymph node metastasis is an important mechanism in the development of stomal recurrence and thus has considerable implications for the prevention of such a recurrence following laryngectomy in the patient presenting with malignant airway obstruction.
Ventricular tachycardia with congenital ventricular diverticulum. A 24-year-old man presented with symptomatic, recurrent, sustained ventricular tachycardia (VT). He was found to have a basal inferior left ventricular diverticulum. His sustained VT was reproduced by programmed electrical stimulation and was unresponsive to procainamide, tocainide, propafenone, and flecainide. Endocardial mapping followed by resection and cryoablative surgery was performed. The patient had only one recurrence after 18 months, with subsequent control with procainamide for over 14 months.
Mitochondrial encephalomyopathies in childhood. I. Biochemical and morphologic investigations. During a 4-year period (1984 to 1988), 50 children referred with manifestations of central nervous system or neuromuscular disease combined with hyperlactatemia were subjected to investigations that aimed to identify and characterize children with mitochondrial disorders. Biochemical and morphologic investigations of quadriceps muscle biopsy tissue were done, including oximetric and spectrophotometric analysis of the respiratory chain function, enzyme histochemistry, electron microscopy, and analysis of mitochondrial DNA. A diagnosis of mitochondrial disease was based on the presence of at least two of five criteria: (1) abnormal results of oximetry, (2) abnormal results of spectrophotometry, (3) enzyme histochemical evidence of cytochrome x oxidase deficiency, (4) deletions or point mutations of mitochondrial DNA, and (5) abundant ultrastructurally abnormal mitochondria. With the combined biochemical and morphologic investigation, 20 of the children were found to have mitochondrial disorders. In an additional 10 children a mitochondrial disorder was neither excluded nor verified. Mitochondrial disorders are thus an important cause of central nervous system and neuromuscular disease in children with hyperlactatemia.