shukoor65/lab-rag-model huggingface dataset:
Pregnancy-induced hypertension and low birth weight: the role of calcium. Considerable interest has developed regarding the role of calcium in the regulation of blood pressure. Epidemiologic investigations, laboratory evaluations, and clinical trials all confirm that the relationship between calcium and blood pressure extends to include the pregnant state. On the basis of current information it is clear that calcium supplementation during pregnancy lowers blood pressure. Additionally, the effect of calcium on blood pressure may influence the incidence and/or gestational age of development of preeclampsia. Additionally, the effect on smooth-muscle relaxation detected in calcium-supplemented patients may affect the incidence of prematurity. Although the mechanism for these effects has not been entirely elucidated, calcium supplementation appears to affect circulating concentrations of parathyroid hormone and renin, which may modulate intracellular ionized calcium, resulting in the observed effect on smooth-muscle relaxation. This effect may also be responsible for reduced uterine activity and for a lowering of the incidence of prematurity.
Active idiopathic ulcerative colitis in a patient with ongoing HIV-related immunodepression. It is suspected that immune mechanisms are important in the pathogenesis of ulcerative colitis. The following is a case report of a patient with human immunodeficiency virus-related immunodeficiency whose ulcerative colitis ran a course independent of the depression of his peripheral CD4 cells. Thus, peripheral CD4 cells may have little role in the pathogenesis of ulcerative colitis.
Nonsteroidal antiinflammatory drug therapy in rheumatoid arthritis patients. Lack of association between clinical improvement and effects on sleep. Thirteen patients with rheumatoid arthritis (mean +/- SD age 55.8 +/- 10.5 years) received 20 mg of tenoxicam daily for 90 days following a 3-7 day "washout" period and 4 days of placebo treatment. Clinical evaluations were conducted at the end of the washout period and at monthly intervals thereafter. All-night polysomnography was performed in a sleep laboratory during the last 2 days of placebo treatment and on days 13, 14, 89, and 90 of tenoxicam treatment. Although there was improvement in the patients' clinical condition, there were no treatment-related changes in any of the sleep parameters. Eight of the 13 patients, however, were found to have primary sleep disorders. Four had periodic leg movements during sleep, 3 had sleep apneas, and 1 had a combination of both disorders. The implications of these findings in the treatment of sleep disorders in patients with rheumatoid arthritis are discussed.
Extracorporeal shock wave lithotripsy of gall stones: an in vitro comparison between an electrohydraulic and a piezoceramic device. A comparative study of the effectiveness of two types of lithotripter in fragmenting gall bladder stones is reported. The machines used were a Piezolith 2300, which generates shock waves by the piezoceramic principle, and a Dornier MPL 9000, which produces the shock waves by underwater spark discharge. With each machine, corresponding stones of 45 pairs of weight and volume matched calculi (median volume 0.5 cm3, median diameter 10.5 mm) obtained at cholecystectomy were treated. All stones were successfully disintegrated (fragments smaller than 2 mm) with up to 5400 (median 628) shocks with the Piezolith and 3450 (median 428) shocks with the MPL 9000 lithotripters. With the Piezolith, operating at the highest power setting, a 1.65 fold median higher number of shocks was required for stone fragmentation than with the MPL 9000 at a medium power setting. Stone volume seemed to be the only determinant which affected ease of fragmentation; composition and density of the stones as assessed by computed tomography did not seem to be governing factors.
Combined split anterior tibial-tendon transfer and intramuscular lengthening of the posterior tibial tendon. Results in patients who have a varus deformity of the foot due to spastic cerebral palsy. Twenty patients who had a varus deformity of the foot secondary to spastic cerebral palsy had twenty-two operations involving combined split anterior tibial-tendon transfer and intramuscular lengthening of the posterior tibial tendon, with and without concomitant lengthening of the Achilles tendon. Preoperatively, all patients had had a dynamic varus deformity of the hindfoot and adduction of the forefoot in both the stance phase and the swing phase of gait. At an average follow-up of 6.2 years (range, 2.3 to 8.8 years), there were fourteen excellent, four good, and four poor clinical results. Two patients who had a fixed varus deformity of the hindfoot and one patient who had a very weak anterior tibial muscle had a poor result. We concluded that the combined procedure is effective for correction of a flexible varus deformity of the foot in patients who have spastic cerebral palsy.
Positive regulation of human thyrotropin receptor mRNA by thyrotropin. We have assessed the influence of natural and recombinant thyrotropin (TSH) on mRNA specific for the human TSH receptor (TSHR) in normal and abnormal adult human thyroid monolayer cells. Using physiological concentrations of TSH (less than 100 mU/L), a marked increase in the level of TSHR mRNA was observed within 12 hours and reached a greater than 1000% increase after 24 hours exposure. At high TSH concentrations (greater than 1000 mU/L), this increase in TSHR-specific mRNA was markedly reduced. However, at no time were basal TSHR mRNA levels suppressed even with 100 U/L of TSH for 48 hours. These observations demonstrate ligand-induced up-regulation of the human TSHR mRNA by physiologically relevant concentrations of TSH.
Spinal and supraspinal correlates of nociception in man. The objective of this work was to simultaneously measure pain-related spinal and supraspinal physiological responses in humans. The sural nerve compound action potential (CAP), the spinal withdrawal reflex (RIII), the somatosensory evoked potential (SEP) and subjective magnitude ratings were elicited by electrical stimulation of the sural nerve in 10 healthy subjects. The sural nerve CAP was used to normalize the evoking stimulus current and to help identify the peripheral nerve afferent types contributing to the physiological and psychophysical responses. Normalizing stimulus current to a proportion of that which elicited a just maximal sural nerve CAP significantly reduced individual variability in magnitude ratings, the RIII and the SEP. Pain and RIII responses only occurred at stimulus levels that were greater than or equal to 1.5 x that which produced a just maximal sural nerve CAP and both responses were positively related to stimulus intensity above that level. Activity in the large diameter A beta fibers will be saturated at stimulus levels near that which produced a just maximal CAP, which implies that both the pain and RIII responses can be attributed to recruitment of the smaller diameter A delta fibers. Although the amplitudes of the P200 and P300 peaks of the SEP were significantly related to stimulation at noxious levels, both were also affected by stimulation at innocuous levels. This result implies that these peaks receive contributions from both noxious and innocuous somatosensory processes. Clearly, the non-pain-related components of these SEP peaks must be identified and isolated before their potential in measuring supraspinal nociceptive processes can be fully realized.
Microscopic hematuria: advances in identification of glomerular dysmorphic erythrocytes. The high diagnostic sensitivity and specificity of microscopically visible, typically glomerular dysmorphic erythrocytes for identification of the cause of glomerular bleeding have been recognized worldwide. Although glomerular dysmorphic erythrocytes are simple to detect on phase contrast microscopy, immediate microscopic diagnosis still is indispensable, since a change in the morphology of the erythrocytes with restriction of the diagnostic relevance is anticipated because of the high autolytic potency of the urine. It may be postulated that this need for immediate diagnosis has led to the method being neglected owing to the high work load at hospitals and physician offices. Moreover, a physician who does not perform microscopic investigations or who lacks experience with the method will not be able to use this diagnostic technique, since it appeared to be impossible to transport urine samples by mail. In the context of a study comprising 30 patients, of whom 10 had histologically confirmed glomerulonephritis, we have shown that glomerular dysmorphic erythrocytes have a manifest form stability for at least 3 days. The preservative used was thimerosal. Also, the urine can be investigated independent of time even after alcoholic Papanicolaou staining without an alteration of erythrocyte morphology. The practicality of the form stability of glomerular erythrocytes can be exploited in everyday medical routine. There are well founded prospects that the rate of early diagnosis of glomerulonephritis will increase.
Fasting gastric pH and its relationship to true hypochlorhydria in humans. Abnormally low rates of gastric acid secretion (hypochlorhydria) are associated with bacterial overgrowth, enteric infection, and with hypergastrinemia and an increased risk of gastric neoplasms. In the present study, we evaluated the ability of fasting gastric juice pH measurements to detect true hypochlorhydria. True hypochlorhydria was defined as a peak acid output in response to a maximally effective stimulant of acid secretion that was below the lower limit of normal for 365 consecutive healthy subjects. In these healthy subjects, average basal pH was 2.16 +/- 0.09 in men and 2.79 +/- 0.18 in women. In 109 consecutive experiments in 28 subjects with true hypochlorhydria, fasting gastric pH averaged 7.44 +/- 0.11 in men and 7.65 +/- 0.33 in women. Fasting pH exceeded the upper 95% confidence limit of normal (5.09 in men and 6.81 in women) in 102 of the 109 experiments (94%). Thus, fasting pH measurement was a sensitive method for diagnosing bona fide hypochlorhydria.
Congenital anomalies in children of patients who received chemotherapy for cancer in childhood and adolescence. BACKGROUND. Many patients who have been treated successfully for childhood cancer with regimens that contain one or more mutagenic chemotherapeutic agents are concerned that their own treatment during childhood or adolescence may adversely affect their children. METHODS. To determine the effect of chemotherapy for cancer during childhood and adolescence on the outcome of subsequent pregnancies, we reviewed the records of 306 men and women who had been treated for pediatric cancer and who responded to our questionnaire. One hundred of the 306 patients reported 202 pregnancies. Among the patients who had received chemotherapy as part of their treatment for cancer, 60 patients or wives of patients had had one or more pregnancies of 20 or more weeks' gestation. The 60 former patients had a total of 100 live-born and 2 stillborn children. RESULTS. The frequency of congenital anomalies was 8.1 percent (5 of 62) among the live-born children of the women and 7.9 percent (3 of 38) among the live-born children of the men. Structural congenital cardiac defects were identified in 10.0 percent (2 of 20) of the children of women who had been treated with dactinomycin, as compared with 0.6 percent (144 of 24,153) among the children in a multicenter survey of fetal anomalies (P = 0.0126). We found no relation between the number of mutagens received or the cumulative dose of any agent received and the frequency of congenital anomalies in the children. CONCLUSIONS. These data suggest that treatment of children and adolescents with mutagenic chemotherapeutic agents, in the dose ranges we examined, does not increase the frequency of congenital anomalies in the children subsequently born to the former patients. However, the possible adverse effect of dactinomycin on the children of such patients requires further study.
Laboratory correlates and prognostic significance of granular acute lymphoblastic leukemia in children. A Pediatric Oncology Group study. As part of a comprehensive prospective clinicopathologic study by the Pediatric Oncology Group (POG), 2,092 children with acute lymphoblastic leukemia (ALL) were evaluated by uniform morphologic, cytochemical, and immunologic methods to assess the frequency and implications of granular lymphoblasts. All cases were Sudan black or myeloperoxidase negative and met French-American-British (FAB) morphologic criteria for ALL. Granular ALL, characterized by the presence of more than 5% marrow blasts with at least three clearly defined azurophilic cytoplasmic granules, was identified in 56 of the 1,252 fully studied cases (4.5%). The frequency of granular features did not differ among early pre-B (4.3%), pre-B (3.6%), and T (5.8%) ALL; no cases were identified among the 12 patients with B ALL. Within the early pre-B/pre-B group, granular ALL was equally distributed between good- and poor-risk clinical groups but was more frequent among FAB L2 than FAB L1 cases (12% vs. 2%; P less than or equal to 0.001). Patients were treated with standard POG protocols for early pre-B/pre-B and T ALL. Complete remission (CR) rates were significantly lower for those with granular lymphoblasts, regardless of risk group, immunophenotype, or FAB type. Analysis of event-free survival (EFS) showed a significantly poorer outcome for granular early pre-B/pre-B cases with FAB L2 morphologic characteristics (P less than 0.001) and for those classified as poor risk (P = 0.015). These findings suggest a relationship between granules and L2 morphologic characteristics in childhood ALL and indicate that the presence of granular lymphoblasts conveys a worse prognosis for certain subgroups of children with ALL.
Lymphomas of true histiocytic origin. Expression of different phenotypes in so-called true histiocytic lymphoma and malignant histiocytosis. The authors determined the phenotypes of neoplastic cells in true histiocytic lymphoma and malignant histiocytosis by using a large panel of monoclonal antibodies and enzyme histochemistry procedures. Although the phenotypes overlapped slightly, the authors noted a distinct pattern in these tumors. The tumor cells of malignant histiocytosis generally expressed the monocyte markers CD11b, CD11c, CD14, and CD45, especially after induction with phorbol ester. In contrast, the tumor cells of true histiocytic lymphoma exhibited a marker expression very similar to that of Reed-Sternberg cells in Hodgkin's disease. These cells expressed markers CD30, 2H9, and 1A2, but rarely expressed CD11b, CD11c, CD14, or CD45. Regardless of their cytologic features, the tumor cells from both types of histiocytic lymphoma exhibited diffuse nonspecific esterase and acid phosphatase activities, and they expressed histiocyte markers CD15, CD68, LN5, 1E9, and M387 to varying degrees. The tumor cells from both lymphomas did not exhibit T- or B-cell markers, T-cell receptor or immunoglobulin gene rearrangements, or gene translation products, even when they were induced with phorbol ester. The phenotypic expression in these two histiocytic malignancies suggests that they are derived from different types of histiocytes, or from histiocytes in different stages of maturation or differentiation, or from histiocytes that have distinct mechanisms of tumorigenic transformation. The expression of circulating monocyte markers in malignant histiocytosis suggests that this tumor originates in monocytes or free histiocytes, whereas the phenotype of true histiocytic lymphoma is compatible with an origin in fixed histiocytes, which generally are devoid of the monocyte markers CD11b and CD14.
Hypertrophic spinal pachymeningitis: report of two cases and review of the literature. The cases of two patients with idiopathic pachymeningitis hypertrophica that caused progressive paraparesis are presented. Gadolinium-enhanced magnetic resonance imaging was used to demonstrate this pathological entity in one patient, and myelography was used in the other. Decompressive surgery led to significant neurological improvement. The etiology, diagnosis, and management of this disease is discussed, and the literature is reviewed. To our knowledge, this is the first report to describe the features of this rare pathological entity on magnetic resonance imaging.
Prognostic factors in colorectal carcinoma treated by preoperative radiotherapy and immediate surgery. The clinicopathologic staging of colorectal cancer is the subject of recent debate. We studied morphologic variables in a series of tumors resected from 284 patients. Half had been prospectively, randomly allocated to receive a 4-day schedule of preoperative pelvic radiotherapy followed by immediate surgery. There was a significant (P less than 0.01) difference in the distribution of tumors of various histopathologic grades between irradiated (XS) and unirradiated (S) patients and borderline differences in the predictive values of venous spread, tumor grading, and local spread. However, these differences were less marked in 180 tumors examined by one review pathologist. They were thought to be due to misinterpretation of changes induced by radiotherapy. No differences were detected in the distribution of tumors of various sizes and Dukes' stage in the XS and S groups. The review pathologist recorded a borderline (P = 0.049) difference in the distribution of tumors of various CEA staining patterns between the XS and S groups. In a Cox regression model. Dukes' staging remained the most important predictive variable for survival and pelvic recurrence in the XS and S groups. Dukes' staging was apparently unchanged by this schedule of preoperative radiotherapy, but Broders' grading may be unreliable. Any new clinicopathologic staging system for colorectal cancer should record when preoperative radiotherapy is delivered. More studies of radiotherapy effects are required.
Chlamydia trachomatis in the etiology of acute otitis media. In an effort to show that Chlamydia trachomatis (CT) may be involved in the causation of acute otitis media (AOM), we performed three experiments. In the first, we inoculated the tympanic bullae of 6 chinchillas with CT. Five of the 6 inoculated animals developed CT AOM. In the second experiment, we sprayed the nasopharynx of 10 chinchillas with CT. Of these, 8 developed both pharyngitis and AOM, and in 6, live CT was cultured from the middle ear and pharynx. In the third experiment, 5 chinchillas had their conjunctiva inoculated with CT. Three developed CT conjunctivitis. Of these, 2 developed CT pharyngitis and 1 developed CT AOM. We concluded that CT will cause AOM in the chinchilla by direct inoculation into the middle ear as well as indirectly by infection of the nasopharynx and conjunctiva.
Is melanoma changing? Nine hundred ninety-five cases of melanoma of the head and neck were divided into two groups so that certain comparisons could be made concerning the behavior of melanoma over a 55-year period. One hundred twelve melanomas of the ocular system were excluded from this review. The first group consisted of 660 melanomas seen during a period from 1932 to 1972. The second group consisted of 223 melanomas seen during a period from 1973 to 1987. Thirteen parameters, including sex, age, distribution, pre-existing mole, amelanotic melanoma, delay in diagnosis, classification, levels, local recurrence, regional metastasis, systemic metastasis, morbidity, and survival, were studied to assess the behavior and the variations. There is no question that the most important aspect of the favorable changes that have occurred are because of earlier diagnosis and better management by a larger group of well-trained specialists. There are some subtler changes that could possibly indicate biologic alterations, but this requires more time and study to substantiate.
A controlled study of disruptive vocalizations among geriatric residents in nursing homes. This paper reports the results of a controlled study comparing geriatric residents in nursing homes who displayed disruptive vocalizations with residents in a comparison group. Two 350-bed nursing homes were surveyed, and it was found that 11% of the residents engaged in disruptive vocalizations, at least once per week, of sufficient severity to require consideration in the resident's care plan. Results show that disruptive vocalizers were more functionally impaired and were more likely to receive a diagnosis of dementia. They were also more likely to display a higher activity level and to experience sleep disturbance and to be prescribed neuroleptic medications. Descriptive data are presented on typology of disruptive vocalizations, likely situations for their occurrence, and the utilization and perceived efficacy of common interventions. Suggestions are made regarding behavioral treatments for this vexing problem.
Neonatal hyperbilirubinemia and physical and cognitive performance at 17 years of age. To estimate the effect of neonatal hyperbilirubinemia on long-term cognitive ability in full-term newborns with a negative Coombs test, we performed a 17-year historical prospective study of 1948 subjects. Intelligence tests and medical examinations performed at the military draft board were stratified according to serum bilirubin concentration. A logistic regression analysis was used to adjust for the confounding effects of gestational age, birth weight, Apgar score, ethnic origin, socioeconomic class, paternal education, birth order, and the administration of phototherapy and exchange transfusion. No direct linear association was shown between neonatal bilirubin levels and intelligence test scores or school achievement at 17 years of age. However, the risk for low intelligence test scores (IQ score less than 85) was found to be significantly higher (P = .014) among full-term male subjects with serum bilirubin levels above 342 mumol/L (20 mg/dL) (odds ratio, 2.96; 95% confidence interval, 1.29-6.79). This association was not observed among female subjects. We conclude that severe neonatal hyperbilirubinemia, among full-term male newborns with a negative Coombs test, could be associated with lower IQ scores at 17 years of age.
Hamartomas of the breast. The clinical and pathologic findings of 17 hamartomas of the breast were studied. All neoplasms were evident as clinically and mammographically discrete masses. The pathologic findings were varied and included circumscribed fibrocystic disease, adenolipoma, fibroadenoma with fat and fibroadenoma with lobules. The heterologous elements identified were cartilage and smooth muscle. All lesions were treated by simple excision. In this study, four different microscopic patterns of hamartoma are described and the necessity for a close clinicopathologic correlation is pointed out in the diagnosis of this lesion.
PET studies of fluorodeoxyglucose metabolism in patients with recurrent colorectal tumors receiving radiotherapy. Forty-four patients with recurrent colorectal carcinoma were examined prior to a combination of conventional photon radiotherapy (40 Gy) and neutron therapy (10 Gy). Twenty-one of these underwent a PET examination after photon therapy and 12 also were studied after the end of combined therapy. CEA plasma levels were measured from blood samples taken immediately before the PET study. A significant decrease in FDG uptake despite good palliative results were observed in only 50% of the patients. This may be explained by inflammatory reactions caused by radiation injury. Inflammation and metabolically active residual tumor tissue cannot be distinguished. It is concluded that an observation interval longer than 6 mo may more effectively detect residual tumor activity. In 14 of 41 examinations, an increased FDG uptake was associated with a normal CEA value, and in only two cases were normal FDG uptake values and increased CEA levels found, suggesting that PET is more sensitive than the measurements of CEA plasma levels for tumor recurrence.