shukoor65/lab-rag-model huggingface dataset:
Papular mucinosis in L-tryptophan-induced eosinophilia-myalgia syndrome. Five patients with the L-tryptophan-related eosinophilia-myalgia syndrome had a generalized eruption of flesh-colored papules. In all patients, histologic examination revealed a focal accumulation of mucin in the upper mid dermis, associated with increased dermal cellularity. The mucin was composed predominantly of hyaluronic acid, with small amounts of sulfated acid mucopolysaccharides. The cells within the lesion were fibroblasts. The lesions slowly regressed after L-tryptophan was discontinued. Proposed explanations for the L-tryptophan-related eosinophilia-myalgia syndrome have centered on contaminants, chemically related to L-tryptophan, introduced in the manufacturing process. Tryptophan metabolites have been linked with sclerotic cutaneous diseases but have not been previously implicated in cutaneous mucinoses.
Fludarabine: a review. The new fluorinated adenine analog, fludarabine, has been tested for efficacy in many tumor types over the past ten years. Two other similar nucleoside analogs are currently available for commercial use. Cytarabine is used principally as an antileukemic agent, and vidarabine as an antiviral. Unlike vidarabine, fludarabine is resistant to deactivation by adenosine deaminase. Data from Phase I and II trials suggest that fludarabine is potentially effective in a number of leukemias, including acute lymphocytic leukemia, acute nonlymphocytic leukemia, and chronic lymphocytic leukemia (CLL). Unfortunately, the doses required to achieve adequate response in the acute leukemias (greater than 75 mg/m2) were above the maximum tolerated dose, resulting in intolerable granulocytopenia, thrombocytopenia, and a life-threatening neurotoxic syndrome. In CLL: however, the dose required to achieve a satisfactory response is well within tolerated limits. Long-term survival statistics are not yet available, but historical perspective strongly correlates response to other agents with increased survival times. Toxicities seen at dose regimens of 15-40 mg/m2/d for five consecutive days include somnolence, metabolic acidosis, confusion, fatigue, nausea, vomiting, increase in serum creatinine and aminotransferase concentrations, and pulmonary and hepatic abnormalities. Mild to severe hematologic toxicity has been observed at all dose levels.
Endovascular treatment of intracerebral arteriovenous malformations: experience in 49 cases. The authors report the results of treatment in 49 consecutive patients with brain arteriovenous malformations (AVM's) who underwent therapeutic embolization with liquid adhesive agents between 1984 and 1988 at the Toronto Western Hospital. Thirty-three patients had no other treatment and were followed up with angiography at 2 years and clinically from 2 to 6 years. Of the other 16 patients, 10 had adjunctive radiosurgery and six underwent surgical resection following embolization. Seven (14%) of the 49 patients had a morphological cure effected by embolization as evidenced on their 2-year follow-up angiograms: these have remained clinically stable. Twelve patients developed neurological deficits after embolization; eight (16% of the series) were transient and four (8%) were permanent. Two patients (4%) had a delayed hemorrhage after incomplete obliteration of their malformations. Endovascular treatment resulted in clinical improvement in 15 (33%) of the other 46 patients. None of the patients who initially presented with hemorrhage had a rebleed following embolization. It is concluded that endovascular treatment with liquid embolic material can be an integral part of the multidisciplinary treatment protocol for patients with brain AVM's.
Upper gastrointestinal lesions in elderly patients presenting for endoscopy: relevance of NSAID usage. The occurrence of upper gastrointestinal disease and the relevance of nonsteroidal antiinflammatory drug (NSAID) usage were documented in 511 consecutive patients (321 women, 190 men) over 70 yr old, referred for upper gastrointestinal endoscopy in a district general hospital. The findings were benign esophageal disease (43%), normal (15%), gastric ulcer (11.5%), and duodenal ulcer (11%). Gastric ulcers were more common in women taking NSAIDs (25%) than in NSAID abstainers (7%) p less than 0.001 and male NSAID users (8%) p less than 0.001. Esophagitis and esophageal stricture were not influenced by NSAID usage, but gastric erosions were more common (10% vs. 3%) p less than 0.01. Of 142 patients receiving NSAIDs, 41% presented with hemorrhage, compared with 20.5% of NSAID abstainers (p less than 0.001). Hemorrhage was as common in aspirin takers (15 of 33, 45%) as in standard-dose NANSAID takers (43 of 109, 39%), even though 86% were taking 300 mg of aspirin per day or less. In elderly patients, esophageal disease is common. NSAID use, even low-dose aspirin, is associated with an increased risk of hemorrhage. In females, NSAID usage is associated with gastric ulcer.
Comparison of restorative proctocolectomy with and without covering ileostomy in ulcerative colitis. The experience of restorative proctocolectomy for ulcerative colitis is reported in 16 consecutive patients with no covering ileostomy (group 2) in comparison with 15 patients with a covering stoma (group 1); in each group a J pouch was constructed. All patients had pre- and postoperative clinical and manometric evaluations of the functional result up to 12 months. There were no deaths or permanent failures. The number of early complications was four in each group. Re-ileostomy was needed in one patient of group 1, and an ileostomy was constructed in three patients of group 2. At 1 year after operation the functional results did not differ between groups 1 and 2 in terms of daily frequency of defaecation (mean 5.6 and 5.4 in 24 h respectively), or in terms of anal basal or maximal squeeze pressures. There was a significant (P less than 0.01) saving in total hospital stay (median 11 days) and in operating theatre time (mean 41 min) in patients with no covering ileostomy. It is concluded that a covering ileostomy may be unnecessary in restorative proctocolectomy, at least in suitable cases with no technical difficulty at the time of operation.
Characterization of severely and profoundly hearing impaired adults attending an audiology clinic. Despite the fact that around 12 per cent of adult patients attending an audiology department will be severely hearing impaired (pure tone averages of 0.5, 1, 2 and 4 kHz of 70 dB HL or worse in the better hearing ear), their clinical and audiometric characteristics have not been well documented. These characteristics were collected prospectively in 132 adult patients attending a Severe Impairment Clinic, set up to manage their specific problems. The inability to provide sufficient masking makes audiometric assessment of the severity of the impairment uncertain in the poorer hearing ear in 52 per cent of these patients. In addition, the limited bone conduction output makes it almost invariably impossible to assess the masked bone conduction thresholds and hence the air-bone gap in the poorer ear. Hence, accurate characterization is only practical of the better hearing ear in such patients. In 67 per cent of the better hearing ears, there was a mixed hearing impairment, the air-bone gap being 20 dB or greater. The aetiology of the conductive component was almost equally otosclerosis and chronic otitis media. In only 19 per cent was the impairment of a pure sensorineural type, broken down as 6 per cent congenitally acquired, 5 per cent due to meningitis and 9 per cent being adult in onset. In the remaining 14 per cent of patients the type of impairment could not be classified as the bone conductive thresholds were off scale. Having had experience of managing these patients at a special clinic and knowing the workload involved, it is argued that consideration be given to setting up such clinics in most departments.
Agglutination of blood cardioplegia by cold-reacting autoantibodies. Cold-reacting autoantibodies occasionally occur in patients requiring cardiac operations. This report describes the clinical course of 1 patient with cold-reacting autoantibodies and intracoronary agglutination of the blood cardioplegia solution. Observations made in vivo and in vitro are considered in discussing recommendations for the management of extracorporeal circulation and cardioplegic arrest in patients with clinically silent cold-reacting autoantibodies.
Toward an integrated understanding of fibromyalgia syndrome. I. Medical and pathophysiological aspects. Fibromyalgia syndrome (FS) is a chronic pain disorder characterized by diffuse musculoskeletal soreness, stiffness, non-restorative sleep and psychological disturbance. At present, much about the etiology, pathological mechanisms and course of FS are unknown. Indeed, standardized diagnostic criteria have only been recently agreed upon. The present paper is the first of a two-part series which reviews the extant empirical literature concerning FS, with a view to arriving at an integrated understanding of the syndrome. The present paper describes the clinical presentation of FS and historical conceptualizations of the disorder. Available research on pathophysiological mechanisms in FS is then presented. In this section we have included literature concerning histology of muscle, sleep architecture, neurotransmitter anomalies and neuropeptide involvement in FS symptomatology.
Peripheral ameloblastoma: a clinical and histologic study of 11 cases. Peripheral ameloblastoma (PA) is a rare odontogenic tumor. Previously, only 39 cases of PA had been reported in the English literature. In this article 11 additional cases of PA are presented. Concordance with previous cases was evident with regard to race, clinical appearance, and site of predilection. However, differences were observed with regard to age, sex distribution, and predominant histologic pattern. The average age in the current cases is younger, there is no male bias, and the most common histologic pattern is plexiform rather than follicular or acanthomatous. Recurrence following simple excision is rare, but has been reported. Long-term postoperative follow-up is recommended.
Primary breast lymphoma. Primary breast lymphoma (PBL) is a rare tumor of the breast. Three cases of PBL are being described. All three cases achieved remission following biopsy, chemotherapy, and/or radiotherapy. The literature is extensively reviewed with emphasis on true incidence of PBL and survival rates.
High-attenuation mediastinal masses on unenhanced CT. On unenhanced CT scans, a variety of mediastinal masses contain areas with attenuation values higher than the attenuation value of the chest wall musculature. The increased attenuation may be diffuse or focal and may be a result of calcium deposition, high iodine content, or areas of acute hemorrhage. This report illustrates the gamut of high-attenuation mediastinal masses seen on unenhanced CT. Masses that are of high attenuation only on IV contrast-enhanced images (e.g., aberrant vessels) are not included.
Subeschar tissue fluid: a source of cell-mediated immune suppression in victims of severe thermal injury. Thermal injury results in pronounced physiologic alterations in microcirculation at the site of tissue damage. The consequence of these changes is an increase in microvascular permeability, leading to the accumulation of tissue edema, or subeschar tissue fluid (STF). One of the adverse properties of edema is its capacity in vitro to inhibit cell-mediated immune function. Since previous studies evaluated STF collected 5 to 7 days after thermal injury, the present study was designed to determine the time frame during which STF demonstrates its immune suppressive nature. Seven patients with severe thermal injury (30% to 100% total body surface area) were entered into the study. STF was collected in serial fashion, beginning as early as 9 hours after injury and continuing until fascial excision or patient death (maximum of 139 hours after injury). The addition of STF to cultures of lymphocytes obtained from healthy donors resulted in complete inhibition of mitogen-induced lymphocyte proliferation (MILP). Serum collected concomitantly from this group of patients was also capable of inhibiting MILP. From its inception, STF possesses the ability to inhibit MILP; this suppressive nature is stable, persisting for prolonged periods of time. The gradual absorption of STF likely contributes to the serologic evidence of cell-mediated immune suppression documented in victims of severe thermal injury.
Protooncogenes and growth factors associated with normal and abnormal liver growth. Hepatocyte replication during liver regeneration depends on extrinsic (circulating) and intrinsic (intrahepatic) factors. Two important growth factors produced in the regenerating liver are discussed, TGF alpha, an autocrine, stimulatory growth factor, and TGF beta, a paracrine inhibitory factor. The balance between the activities of these factors is likely to play an important role in regulating hepatocyte proliferation. The expression of some protooncogenes occurs sequentially during the first few hours after partial hepatectomy and is a marker for the entry of hepatocytes into the cell cycle (proliferative competence). As hepatocytes become competent to proliferate, they respond to TGF alpha and other growth factors and enter a proliferative phase. It is possible that TGF beta 1 serves as a stop signal for liver regeneration but the mechanisms by which TGF beta inhibits hepatocyte DNA synthesis are still unknown.
Relation of psychopathology in general medical inpatients to use and cost of services. The authors investigated the relation between psychopathology in medically ill inpatients and use and cost of medical care services. Of 455 medical inpatients, the Medical Inpatient Screening Test identified 27.9% as very depressed, 27.5% as very anxious, 20.2% as having cognitive dysfunction, and 8.6% as having high pain levels. Overall, the test identified 51% of the patients as having high levels of psychopathology or pain. These subjects had a 40% longer median length of hospital stay and 35% greater mean hospital costs than those with low levels of psychopathology or pain. Patients with greater psychopathology also had higher hospital charges, more procedures during hospitalization, and more discharge diagnoses but did not differ from the other patients in sex, race, age, diagnosis-related group (DRG) major diagnostic category, or DRG weight.
Enhancement of pulsed-dye laser ablation of arterial tissues with blood medium: effects of laser-induced shock waves. The influence of blood medium on tissue ablation by a pulsed dye laser and its selectivity for atheroma were investigated. The role of shock waves on tissue ablation was also evaluated. Normal and atherosclerotic human aortas were irradiated by a 480 nm pulsed dye laser activated at 5 Hz. The laser was coupled with a single 0.2 mm fiber (Uni-guide) (40 mjoules/pulse) or a multifiber catheter (14 x 150 microns) (100 mjoules/pulse). Shock waves were measured using a fluid-filled catheter connected to a strain gauge manometer. With the Uni-guide, pulse-dye lasing resulted in greater ablation of atheroma in blood (11.6 x 10(-3) mm3/joule, p less than 0.001 versus atheroma measured in saline and normal tissue in blood) followed by normal tissue in blood (2.5 x 10(-3)mm3/joule), atheroma in saline (1.71 x 10(-3)mm3/joule, p less than 0.05 versus normal tissue in saline), and normal tissue in saline (0.54 x 10(-3) mm3/joule). With the multifiber catheter, laser ablation was the greatest in atheroma in blood (0.55 +/- 0.26 mm3/joule p less than 0.001 versus atheroma in saline and normal tissue in blood), followed by normal tissue in blood (0.27 +/- 0.12 mm3/joule), atheroma in saline (0.14 +/- 0.15 mm3/joule, p less than 0.001 versus normal tissue in saline), and normal tissue in saline (0 mm3/joule). The ablation efficiency of the multifiber catheter was greater than that of the Uni-guide (p less than 0.0001).
Isolated incisional metastases after intraperitoneal radioactive chromic phosphate therapy for ovarian carcinoma. Two women developed apparently isolated recurrences of ovarian carcinoma involving prior incisions after receiving intraperitoneal radioactive chromic phosphate (P-32) adjuvant therapy for early epithelial ovarian carcinoma. Both are alive without evidence of disease at second-look laparotomy after surgical resection of the abdominal wall metastases and cisplatin-based combination chemotherapy. Mechanisms of cutaneous and incisional implantation metastases are discussed. Adjuvant therapy with intraperitoneal P-32 is unable to provide systemic therapy for occult metastatic disease. The favorable outcome in these cases probably reflects limited tumor burden at the time of recurrence and stands in stark contrast to other cases of soft tissue recurrences of ovarian carcinoma reported previously.
Blockade of the ATP-sensitive potassium channel modulates reactive hyperemia in the canine coronary circulation. The mechanism of reactive hyperemia remains unknown. We hypothesized that reactive hyperemia was related to the opening of ATP-sensitive potassium channels during coronary occlusion. The resulting hyperpolarization of the smooth muscle cell plasma membrane might reduce calcium influx through voltage-dependent calcium channels and result in relaxation of smooth muscle tone and vasodilation. In eight open-chest, anesthetized dogs, 30-second coronary occlusions resulted in an average flow debt repayment of 200 +/- 41%. After low-dose (0.8 mumol/min) and high-dose (3.7 mumol/min) infusion of intracoronary glibenclamide, flow debt repayment fell to 76 +/- 14% and 50 +/- 8%, respectively (p less than 0.05 compared with control for both). The decline in flow debt repayment was due to a significant reduction both in maximum coronary conductance during reactive hyperemia and in its duration. In addition, there was a significant decline in the sensitivity of the coronary circulation to adenosine-induced vasodilation after glibenclamide. While more variable, there was no overall change in the sensitivity of the coronary vasculature to acetylcholine-induced vasodilation after glibenclamide. We conclude that reactive hyperemia is determined in a large part by the ATP-sensitive potassium channel, probably through its effect on membrane potential and voltage-sensitive calcium channels. Because reactive hyperemia was never fully abolished at the highest doses of glibenclamide tested, it is possible that additional mechanisms are involved in the genesis of this complex phenomenon.
Volume tests for chronic venous insufficiency: an appraisal. Chronic venous disease is increasingly treated surgically with a variety of experimental procedures. Noninvasive volume tests are commonly used before surgery to select patients and after surgery to assess results. Rapid volume changes are considered to indicate regurgitation. Rigorous statistical validation of tests and the confounding nature of unmeasured arterial inflow are seldom considered. Volume changes were measured in 29 control limbs and 35 limbs with venous disease, with mercury-in-silicone rubber strain gauges, for both exercise and elevation. Normalization for arterial flow permitted calculation of the regurgitation rate. Normal (95% confidence) limits for measured and calculated parameters were determined. Specificity was shown by the percent of normal parameter values for control limbs and sensitivity by the percent of abnormal values for extremities with venous disease. Arterial flow significantly altered volume curves. Normalization increased specificity and sensitivity significantly. Calf exercise tests, even normalized, were too insensitive to be reliable. Elevation tests were significantly more sensitive for determining regurgitation. However, exercise tests were useful and supplied important information about the calf muscle pump. We conclude that, as currently used, many limb volume test procedures are unsuitable but could be improved significantly by normalization to reduce the confounding effect of regional arterial flow and use of an elevation test to measure regurgitation.
Identification of a mutation in porcine ryanodine receptor associated with malignant hyperthermia. Malignant hyperthermia (MH) causes neurological, liver, and kidney damage and death in humans and major economic losses in the swine industry. A single point mutation in the porcine gene for the skeletal muscle ryanodine receptor (ryr1) was found to be correlated with MH in five major breeds of lean, heavily muscled swine. Haplotyping suggests that the mutation in all five breeds has a common origin. Assuming that this is the causal mutation for MH, the development of a noninvasive diagnostic test will provide the basis for elimination of the MH gene or its controlled inclusion in swine breeding programs.
Severe oral phenytoin overdose does not cause cardiovascular morbidity. STUDY OBJECTIVE: To evaluate the potential for cardiovascular toxicity from severe oral phenytoin overdose. STUDY POPULATION: Fifty-seven patients admitted during a two-year period to an inner-city hospital for severe oral phenytoin overdose, which is defined as a peak level of 40 micrograms/mL or more. METHODS: Case records were reviewed retrospectively for symptoms and signs of phenytoin toxicity, especially circulatory effects. Baseline and toxic 12-lead ECGs, when available, were reviewed in detail. Continuous variables were compared using either paired or unpaired t tests, as appropriate. Significance was taken as P less than or equal to .05. RESULTS: Mean peak phenytoin level was 49.4 +/- 7.7 micrograms/mL. Continuous single-lead ECG monitoring in 36 patients (63%) for a mean of 26.5 +/- 21.6 hours revealed no incidents of dysrhythmia requiring treatment. ECGs recorded during toxicity in 52 cases (91%) revealed no clinically significant abnormalities attributable to phenytoin. ECGs during toxic and baseline states were available for detailed analysis in 15 cases. Ten patients exhibited an increase in PR interval (mean, 19 +/- 10 ms) when toxic, whereas five had a decrease (mean, 18 +/- 11 ms) compared with nontoxic records. No change in heart rate, QRS duration, or corrected QT interval was observed. There were no circulatory complications and no deaths. CONCLUSION: Cardiovascular toxicity is rarely a manifestation of oral phenytoin overdose. Routine management of stable patients with severe phenytoin overdose in a monitored setting is not mandatory.
Neurotoxicity of intraventricularly administered alpha-interferon for leptomeningeal disease. Nine patients with leptomeningeal disease are reported who were treated with intraventricular alpha-interferon (alpha-IFN). In seven of these patients, a progressive vegetative state developed during treatment. The patients became unresponsive to verbal commands but opened their eyes with auditory or tactile stimulation. It took an average of 3 weeks for these patients to become verbally responsive after treatment was discontinued. Electroencephalographic findings showed evidence of irritative involvement of the deep midline nuclei in 80% of patients. Periventricular white matter changes developed during treatment in three of six patients who underwent computed tomographic scans. All patients with this severe neurotoxicity received whole-brain irradiation before treatment. Possible mechanisms for the development of this neurotoxic syndrome are discussed. The neurotoxicity of alpha-IFN and brain irradiation may be additive, suggesting a cautious approach when using this combination for treatment.