shukoor65/lab-rag-model huggingface dataset:
Abrupt outpatient withdrawal of medication in analgesic-abusing migraineurs. 46 migraineurs with secondary chronic daily headache were treated for medication abuse as outpatients by abrupt withdrawal of the offending drugs. The patients were supported with adequate explanation of the disorder, regular follow-up, amitriptyline (10 mg at night), and naproxen (500 mg) for relief of headache symptoms. By 6 months of follow-up 37 patients had relief from chronic headaches, and analgesic intake had become intermittent and appropriate to the original occasional migraine episodes. 6 had substantially reduced analgesic intake, but headache severity was unchanged; 2 had not managed to reduce intake and headache was unchanged; and 1 patient withdrew after the first visit.
Factors affecting compliance with screening sigmoidoscopy BACKGROUND. A retrospective, qualitative study in a university setting was undertaken to better understand factors influencing patient compliance with screening sigmoidoscopy. METHODS. Individuals who completed screening sigmoidoscopy were interviewed to learn about the physician-patient relationship, general knowledge of cancer, family experience with cancer, exposure to the media, and specific reasons why sigmoidoscopy was completed. RESULTS. Respondents reported that their physician's recommendation had a strong positive influence on their decision to have sigmoidoscopic screening, as did their family and personal experiences with cancer. In all cases, the patients stated that they would not have had a sigmoidoscopy without the recommendation of their physician. Respondents were little influenced by exposure to the media or by famous personalities. CONCLUSIONS. The importance of the physician's recommendation for the patient to have sigmoidoscopy and demonstration of concern with early cancer detection may represent the primary motivating factors in completion of screening sigmoidoscopy.
An improved method for the quantification of left-to-right cardiac shunts. We have investigated a technique for quantifying QP/QS in left-to-right cardiac shunts. In this method, the gamma variate, which is fitted to the first-pass portion of the lung curve, is used to generate a curve, which simulates the response of a normal lung curve with systemic recirculation. The difference between this curve and the observed lung curve is then used to calculate QP/QS. This method was evaluated on a set of simulated lung time-activity curves with precisely known QP/QS values on a group of 11 patients with no clinical suspicion of cardiac shunt and on a group of 30 patients referred for cardiac shunt studies. The QP/QS in each of these studies was determined by three individuals using both the Maltz-Treves method and the new method. This method yielded QP/QS values that were more accurate on the simulated lung data and had less interobserver variation on all the studies than those obtained from the Maltz-Treves method.
Diffuse Lewy body disease presenting with a supranuclear gaze palsy. A patient with diffuse Lewy body disease presented with supranuclear vertical and horizontal ophthalmoplegia, dementia, axial rigidity and falls, bradykinesia and pyramidal signs. This broadens the clinical presentation of this pathological diagnosis and re-emphasises the heterogeneity of patients diagnosed clinically as progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome).
Arboviral infections in the United States. Arboviruses are important considerations in the differential diagnosis of encephalitis and other acute infections. Alterations in the environment and in human behaviors contribute to changing patterns of arboviral transmission. These trends, the periodic epidemic resurgence of arboviral diseases such as St. Louis encephalitis, and the discovery of new arboviruses present a continued challenge to infectious disease clinicians.
Changes in protein, RNA and DNA and rates of protein synthesis in muscle-containing tissues of the mature rat in response to ethanol feeding: a comparative study of heart, small intestine and gastrocnemius muscle. 1. The relative sensitivity of heart, small intestine and skeletal muscle to chronic ethanol feeding was investigated in mature Wistar rats fed ethanol as 36% of total energy intake; controls were fed the same diet in which ethanol was substituted by isoenergetic glucose. 2. Chronic ethanol feeding had no apparent effect on the protein, RNA and DNA contents of heart homogenates (atria and ventricles). The ratios of RNA/protein (synthetic capacity), RNA/DNA (synthetic material per nucleus) and protein/DNA (DNA-unit or apparent cell size) were also unaltered in the hearts of alcohol-fed rats. Fractional rates of cardiac protein synthesis (ks), and synthesis relative to RNA (kRNA) and DNA (kDNA) and absolute rates of protein synthesis (Vs) were unaffected by ethanol feeding. The total content of cardiac soluble proteins was unaltered by chronic ethanol feeding, but there were small and statistically significant decreases in the contents of the myofibrillar and stromal protein fractions. There were no differences in ks in any of the cardiac subcellular protein fractions. 3. In the small intestine, ethanol feeding had no statistically significant effect on either protein or RNA contents, but there was an apparent increase in RNA when expressed relative to either protein or DNA, though the DNA-unit was unaltered. There were also substantial decreases in ks, kRNA, kDNA and Vs of approximately 15-35%. 4. In the gastrocnemius, RNA contents were significantly reduced by ethanol feeding but protein and DNA contents were unaffected. Indices of the synthetic capacity and synthetic material per nucleus were also reduced, but the DNA-unit was unaltered. These observations were accompanied by approx. 15-30% reductions in ks, kRNA, kDNA and Vs in response to ethanol feeding. 5. It is concluded that various aspects of protein metabolism in the heart, small intestine and skeletal muscle are adversely affected by chronic ethanol toxicity. The characteristics and magnitude of the responses in each tissue differ. Effects in the heart may be subtle, though haemodynamic indices may ensue. The ethanol-induced alterations in the small intestine and skeletal muscle may be responsible for gastrointestinal disturbances in motility and skeletal muscle weakness, respectively.
Collagenous colitis: pathophysiologic considerations. Collagenous colitis, a cause of watery diarrhea characterized by a distinctive band of collagen under the surface epithelium of the colon, has been recognized with increasing frequency in recent years. The pathophysiology of collagenous colitis remains obscure. The thickening of the subepithelial collagen layer may be a response to chronic inflammation or a local abnormality of collagen synthesis. The precise mechanism of the diarrhea in collagenous colitis is also unclear, and it has not been possible to link the diarrhea directly to the excess collagen deposition. The relationship between collagenous colitis and lymphocytic colitis, another type of microscopic colitis, remains to be defined; elucidating the relationship between the two disorders may provide clues to the pathophysiology of both.
Possible linkage of the estrogen receptor gene to breast cancer in a family with late-onset disease. The estrogen-receptor locus is a candidate gene for inherited susceptibility to human breast cancer, particularly among families with later onset, primarily estrogen-receptor-positive tumors. For one extended family with eight patients with late-onset disease, one estrogen-receptor haplotype was consistently coinherited with breast cancer, yielding a +1.85 lod score for linkage at zero recombination. Simulation of this pedigree assuming independent inheritance of breast cancer and estrogen-receptor genotypes led to a lod score greater than or equal to 1.85 only once in 2,000 replicates. We suggest testing linkage of this gene to breast cancer in other families with late-onset disease.
Clinical pharmacology of intravenous enoximone: pharmacodynamics and pharmacokinetics in patients with heart failure. Twenty-one patients with heart failure (New York Heart Association [NYHA] class II to IV) received a 24-hour infusion of enoximone followed by a 12-hour washout period. Patients were randomly assigned to one of four treatment groups. Groups I to III received an 0.5 mg/kg bolus, followed by a maintenance infusion of 2.5, 5.0, or 10.0 micrograms/kg/min. Group IV patients received a maintenance infusion of 5.0 micrograms/kg/min without a loading dose. Serial assessment of hemodynamics, plasma levels of enoximone and enoximone sulfoxide, and ventricular ectopy were performed. Enoximone produced a clinically significant increase in cardiac index, and a decrease in mean pulmonary artery wedge pressure and systemic vascular resistance in all groups. Enoximone mildly increased heart rate, and had a minimal effect on mean arterial pressure. There was no statistically significant change in ventricular ectopy during the infusion. Significant hemodynamic improvement was noted at even the lowest infusion rate, and did not increase in linear fashion at higher infusion rates. In patients who did not receive an initial loading bolus of 0.5 mg/kg, the increase in cardiac index was delayed by approximately 1 hour. Plasma concentrations of both enoximone and its major metabolite continued to rise throughout the 24-hour infusion in group III (10.0 micrograms/kg/min), rather than reaching steady state as predicted by the terminal exponential half-lives of these compounds. This is suggestive of nonlinear pharmacokinetics and indicates a potential for excessive accumulation of enoximone and its metabolite during prolonged infusion. These findings may have important implications in guiding the intravenous administration of enoximone.
Very severe self-poisoning lithium carbonate intoxication causing a myocardial infarction. A case of severe lithium carbonate self-poisoning is described, presenting with a very high serum lithium level (14.6 mmol/L) on admission. Lengthy and repeated hemodialyses were required to lower lithemia to nontoxic ranges. As is usually reported, our patient had prolonged neurologic manifestations (coma, hyperreflexia, fluctuating focal signs) and developed hypotension, cardiovascular collapse, nephrogenic diabetes insipidus, and diarrhea. Other less common features were the occurrence of acute myocardial infarction without coronary artery lesions and thrombocytopenia. The possible pathogenic mechanisms are discussed. Hemodialysis and supportive intensive care treatment are commented upon. The final outcome was favorable, and the patient recovered completely.
Quantification of ST-segment changes during coronary angioplasty in patients with left bundle branch block. Electrocardiographic manifestations of ischemia are difficult to interpret in the presence of left bundle branch block (LBBB). Recently developed techniques allow continuous computerized digital analysis of ST segments that can be zeroed to the patient's own baseline electrocardiogram even if that baseline is abnormal conduction. With use of this technology, ST-segment changes during balloon coronary occlusion were compared in 10 patients with LBBB versus an age-, sex-, and coronary anatomy-matched population of 20 control subjects with normal baseline conduction. ST-segment deviation of greater than or equal to 1 mm from baseline was present in 80% of patients with LBBB and in 75% of control patients (difference not significant). There was no significant difference between patients with LBBB versus control patients in maximal ST-segment deviation (2.6 +/- 1.7 vs 2.0 +/- 1.0 mm) or in ST-segment deviation measured after 60 seconds of occlusion (2.4 +/- 1.3 vs 1.8 +/- 1.1 mm). ST-segment deviation reached 1 mm more quickly in patients with LBBB (33 +/- 11 seconds) than in control subjects (60 +/- 36 seconds) (p = 0.003). It is concluded that ST-segment analysis is feasible in patients with LBBB using digital self-referenced ST analysis and may provide important clinical information regarding the presence of myocardial ischemia.
Cu,Zn superoxide dismutase is a peroxisomal enzyme in human fibroblasts and hepatoma cells. The intracellular localization of Cu,Zn superoxide dismutase (superoxide:superoxide oxidoreductase, EC 1.15.1.1) has been examined by immunofluorescence using four monoclonal anti-Cu,Zn superoxide dismutase antibodies raised against a recombinant human Cu,Zn superoxide dismutase derivative produced and purified from Escherichia coli. Colocalization with catalase, a peroxisomal matrix enzyme, was used to demonstrate the peroxisomal localization of Cu,Zn superoxide dismutase in human fibroblasts and hepatoma cells. In the fibroblasts of Zellweger syndrome patients, the enzyme is not transported to the peroxisomal ghosts but, like catalase, remains in the cytoplasm. In addition, immunocryoelectron microscopy of yeast cells expressing human Cu,Zn superoxide dismutase showed that the enzyme is translocated to the peroxisomes.
Estrogen receptors, progesterone receptors and heat-shock 27-kD protein in liver biopsy specimens from patients with hepatitis B virus infection. It has been proposed that in the human liver, the estrogen receptor gene may become inappropriately expressed as a consequence of HBV integration, contributing to cell transformation. This study was undertaken to examine estrogen receptor status in patients with hepatitis B virus infection and to analyze the expression of progesterone receptor and of a heat-shock 27,000-D protein (hsp27), both of which are estrogen regulated in estrogen target tissues. Receptor proteins were detected in liver biopsy specimens by immunocytochemistry using antireceptor monoclonal antibodies; a monoclonal antibody was also used to detect hsp27. Estrogen receptor and progesterone receptor were mainly seen in the nuclei of hepatocytes. The presence of hepatitis B virus infection did not always result in elevated estrogen receptor expression, but in general the expression of this receptor protein was higher in hepatitis B virus-positive patients than in patients with the same pathological findings (hepatitis, cirrhosis, hepatocarcinoma) but without hepatitis B virus. This was more clearly seen in the patients with hepatitis. Although estrogen receptor expression was moderate to high in many samples, the expression of the two biochemical markers of estrogen action at postreceptor levels (progesterone receptor and hsp27) was low or absent in most of the liver tissues examined, suggesting that in the liver the interaction of estrogen-estrogen receptor-DNA has characteristics inherent to this tissue.
Fasting plasma glucose levels and endogenous androgens in non-diabetic postmenopausal women. 1. The clinical association between glucose intolerance, hyperinsulinaemia, insulin resistance and hyperandrogenism is well recognized in premenopausal women with polycystic ovarian disease. We examined the hypothesis that fasting plasma glucose levels might be related to endogenous androgen levels in postmenopausal women in the absence of overt clinical disease. 2. In a Southern Californian cohort of 848 nondiabetic postmenopausal women aged 50-79 years, fasting plasma glucose levels positively correlated with levels of the endogenous androgens dehydroepiandrosterone sulphate and free testosterone and negatively with sex-hormone-binding globulin across the whole range of glucose and hormone levels. Mean dihydroepiandrosterone sulphate and free testosterone levels were 16% and 46% higher, respectively, and mean sex-hormone-binding globulin levels 27% lower in the top compared with the bottom quartile of fasting plasma glucose levels. This relationship was independent of age, body mass index, cigarette smoking habit and exogenous oestrogen use. 3. These findings raise questions about the possible physiological role of androgens in the regulation of glucose metabolism and insulin resistance and, possibly, in the mediation of the some of the cardiovascular consequences of diabetes in women.
Pharyngeal function and snoring characteristics in apneic and nonapneic snorers. Abnormalities in pharyngeal function, manifested even when the patients are awake, are thought to play an important role in the pathogenesis of sleep apnea. Tests of awake pharyngeal function continue to stimulate interest because it is hoped that they may allow physicians to distinguish patients with sleep apnea from those without it, and therefore reduce the number of unnecessary sleep studies. We elected to study two measures of pharyngeal function: changes in pharyngeal area with lung volume (PLVD) and changes in pharyngeal area in response to externally applied positive pressure, i.e., pharyngeal distensibility (Cph). Both measurements have been employed for assessment of pharyngeal function, and both are thought to reflect pharyngeal "floppiness." Measurement of PLVD is technically very simple, whereas the measurement of Cph is technically more complex. If the two measurements are highly correlated, it might be possible to replace the technically more difficult one by the simpler one. Consequently, the purpose of this study was two-fold: first, to examine the relationship between pharyngeal distensibility and lung volume dependence of pharyngeal area, and second, to compare these parameters in a large group of confirmed snorers with and without obstructive sleep apnea (OSA). We studied 75 unselected patients referred for the investigation of snoring and suspected sleep apnea. All patients had nocturnal polysomnography, pulmonary function tests, and measurement of pharyngeal areas at TLC, FRC, and residual volume (RV) employing the acoustic reflection technique. The area measurement at FRC was performed at zero and at 4.1 cm H2O positive airway pressure to calculate pharyngeal distensibility.
Ligamentous compression of the celiac axis: CT findings in five patients. Compression of the celiac trunk by the median arcuate ligament of the diaphragm is an uncommon angiographic and surgical finding that rarely may be symptomatic. We retrospectively reviewed contrast-enhanced abdominal CT scans in five patients with severe ligamentous compression of the celiac axis, confirmed by surgery and/or angiography, and compared the findings with those of enhanced scans of 100 consecutive patients without known ligamentous compression. In all five patients with ligamentous celiac artery compression, CT showed effacement or narrowing of the celiac trunk by an anterior soft-tissue band. Dilated peripancreatic collateral vessels were seen in four cases, and poststenotic dilatation of the distal celiac trunk was seen in two cases. The normal appearance of the vasculature was seen in the majority (76%) of the 100 control subjects, but in eight patients the celiac origin was obscured on CT scans, and in 16 patients the celiac trunk appeared narrow or effaced. Our experience suggests that severe ligamentous celiac artery compression can be identified on CT. However, the isolated CT finding of effacement or obscuration of the celiac axis occurs sufficiently often in normal patients that it is not adequate evidence to establish the diagnosis of celiac artery compression.
Tumor cell adhesion to endothelial cells: endothelial leukocyte adhesion molecule-1 as an inducible adhesive receptor specific for colon carcinoma cells. Activation of endothelial cells by the two inflammatory mediators interleukin-1 (IL-1) and tumor necrosis factor strongly increases tumor cell adhesion. We describe antibody inhibition studies showing that the endothelial leukocyte adhesion molecule-1 (ELAM-1), a cell-surface glycoprotein selectively expressed by cytokine-activated endothelial cells and responsible for neutrophil adhesion, is the major, if not the only, mediator of colon carcinoma cell adhesion to activated endothelial cells. Among the different tumor cell lines tested, seven colon carcinoma cell lines were sensitive to ELAM-1 antibodies. Adhesion of melanoma, osteosarcoma, and lung, cervix, or kidney carcinoma cell lines to IL-1-treated endothelial cells was not affected by the ELAM-1 antibody. This result suggests that ELAM-1 is selectively recognized by colon carcinoma cells and that adhesion of tumor cells to activated endothelial cells could be mediated by different and specific mechanisms.
Effect of long-term enalapril therapy on cardiopulmonary exercise performance in men with mild heart failure and previous myocardial infarction. Forty-one men with documented myocardial infarction greater than 6 months previously were randomized to long-term (48 weeks) therapy with placebo or enalapril on a double-blind basis. All patients were receiving concurrent therapy with digitalis and a diuretic drug for symptomatic heart failure (functional class II or III). The mean age was 64 +/- 7.3 years and no patient suffered from exertional chest pain. Patients underwent maximal cardiopulmonary exertional chest pain. Patients underwent maximal cardiopulmonary exercise testing to exhaustion on an ergometer cycle nine times over the course of 48 weeks. Gas exchange data were collected on a breath by breath basis with use of a continuous ramp protocol. In the placebo group (n = 21), the mean (+/- SD) peak oxygen consumption (VO2) at baseline was 18.8 +/- 5.2 versus 18.5 +/- 5.5 ml/kg per min at 48 weeks (-1.4%, p = NS). In the enalapril group (n = 20), the corresponding values were 18.1 +/- 3.1 versus 18.3 +/- 2.6 ml/kg per min (+2.8%, p = NS). The mean VO2 at the anaerobic threshold for the placebo group at baseline study was 13.1 +/- 3.5 versus 12.8 +/- 2.1 ml/kg per min at 48 weeks (-2.2%, p = NS). The corresponding values for the enalapril group were 11.8 +/- 2.3 versus 11.8 +/- 2.4 ml/kg per min (+1.4%, p = NS). The mean total exercise duration in the placebo group at baseline study was 589 +/- 153 versus 620 +/- 181 s at 48 weeks (+5.4%, p = NS).
Gamma glutamyl transpeptidase expression in foetal skin, inflammatory dermatoses and cutaneous neoplasia. Gamma glutamyl transpeptidase (GGT) is an enzyme expressed by some epithelial neoplasms but not normal interfollicular epidermis. In order to examine the relationship between malignant change and de-differentiation we studied histochemically the expression of GGT in human foetal skin, various inflammatory dermatoses and epidermal neoplasms. In foetal skin GGT was detectable after 7 weeks' gestation, reached a maximum at 11 weeks and was undetectable by 24 weeks. It was expressed strongly by squamous cell carcinoma and focally in Bowen's disease and actinic keratoses. There was no GGT expression in basal cell carcinoma or most benign skin tumours, but keratoacanthomas were weakly positive. Keratinocytes in the vicinity of malignant melanocytes also expressed GGT. This study suggests that GGT expression, while not a simple marker of malignancy, may represent reversion to a less differentiated or 'foetal' phenotype.
Primary orbital intraosseous hemangioma. Primary orbital intraosseous hemangiomas are rare--only 16 cases have been reported previously. The authors describe five patients with this benign tumor. Patients ranged in age from 49 to 77 years, and each had a painless or mildly tender nodular lesion. Ophthalmic symptoms were minimal, although nasolacrimal obstruction was the original sign in one patient. Four of five patients responded well to complete tumor excision (two patients) or partial resection of the lesion (two patients). The fifth patient required a second operation for tumor progression after partial excision of the hemangioma. The 16 previously reported cases of orbital intraosseous hemangioma are reviewed, and the natural history and pathology of this rare vascular lesion are discussed.