shukoor65/lab-rag-model huggingface dataset:
Comparison of postoperative complications between saphenous vein and IMA grafts to left anterior descending coronary artery. Considerable controversy exists regarding relative morbidity associated with the saphenous vein graft (SVG) and internal mammary artery (IMA) graft in patients undergoing myocardial revascularization. As a part of the cooperative study on use of antiplatelet drugs for graft patency, operative and postoperative data were prospectively collected on 1,150 patients who underwent either SVG (n = 656) or IMA anastomosis (n = 494) to the left anterior descending coronary artery. There were no differences in baseline characteristics of patients, distribution of randomization among treatment groups, and total number of distal anastomoses performed between the two groups. The aortic cross-clamp time, cardiopulmonary bypass duration, operative time, and chest tube drainage were greater (p = 0.0001) in the patients with IMA grafts compared with SVG. However, there was no difference in the operative mortality rate, the amount of blood and blood products received, the reoperation rate for control of postoperative bleeding, and incidence of wound complications between the two groups. The early and 1-year patency rates for the IMA were slightly but not significantly better than the SVG patency rates (92.8% versus 90.1% for 1-year patency; p = 0.309). In conclusion, use of IMA is associated with a longer operative time as well as increased postoperative bleeding compared with the SVG. It, however, does not increase operative mortality or postoperative morbidity.
Immunoreactive endometritis. A benign polyclonal lymphoid proliferation of the endometrium which bears morphological resemblance to the malignant lymphoma is found among women with bleeding disturbances. Seven previous cases have so far been reported in the literature. A retrospective examination of 11,648 endometrial specimens revealed 287 examples of chronic endometritis (2.5%) of which 29 displayed lymphoid proliferation. We found no evidence of malignant haematologic disorder after a median observation of 68 months and no positive association with prior or present infectious disease. Histological follow-up of ten patients showed that changes could persist for up to 12 months. We name this benign condition 'immunoreactive endometritis'.
The effect of enteric-coated aspirin on the morning increase in platelet activity. In vitro platelet aggregability to adenosine diphosphate (ADP) and epinephrine increases in the morning, as does the frequency of myocardial infarction. A single-blind, randomized, cross-over study of 15 healthy males was conducted to determine: (1) if other measures of platelet activity show a morning increases and (2) if aspirin eliminates any increases in platelet activity detected. Subjects received 325 mg of enteric-coated aspirin (ECA) or placebo. During placebo therapy,platelet thromboxane A2 production (following collagen stimulation) increased significantly after the subjects got up, as did platelet aggregability to ADP, epinephrine, and collagen. ECA markedly reduced baseline platelet thromboxane A2 production and eliminated the increase after the subjects got up. It also abolished biphasic aggregation in response to epinephrine and ADP (thereby eliminating the morning increase in aggregability to these agents), lengthened collagen lag time, reduced synergistic aggregation to combined agonists, was effective on day 2, and did not alter increases of tissue plasminogen activator that occurred following the subjects' arising. If aspirin prevents myocardial infarction by its antiplatelet action, as seems likely, the preferential reduction of morning infarction observed in the Physicians' Health Study, and the demonstration that aspirin eliminates the morning increase in platelet activity, suggest that the morning increase in myocardial infarction is due in part to a concurrent relatively modest increase in platelet activity.
Primary seminoma of the seminal vesicle: report of a case. We report on the clinical and histological findings of a primary extragonadal germ cell tumor that was proved to be a seminoma of the seminal vesicle. The patient had left ureteral obstruction at diagnosis. The testes were normal on physical and ultrasound examination, and the retroperitoneum was free of tumor. There was no recurrence 8 months postoperatively.
PUVA-induced lymphomatoid papulosis in a patient with mycosis fungoides. The occurrence of lymphomatoid papulosis in patients with cutaneous lymphoma, particularly mycosis fungoides, has been described in medical literature. A 68-year-old woman affected by mycosis fungoides in the plaque stage noticed that multiple papulonodular lesions of lymphomatoid papulosis developed suddenly after a few sessions of PUVA therapy. The PUVA induction of lymphomatoid papulosis was confirmed by the appearance of new lesions after a second cycle of PUVA exposure on a limited area of the body. Complete regression of all PUVA-induced lymphomatoid papulosis lesions was achieved within a few weeks with oral prednisone and topical steroids. During the entire treatment the patches and plaques of mycosis fungoides persisted unchanged.
Primary gastric mantle zone lymphoma. A report of two cases. We report two cases of primary gastric mantle zone lymphoma. Histologic examination revealed numerous lymphoid vague nodules in the mucosa and submucosa of the resected stomach. The neoplastic cells in these nodules were slightly larger than small lymphocytes and had more or less cleaved nuclei. Immunostaining on paraffin-embedded sections showed that the neoplastic cells in the nodules of these cases were LN-1- and LN-2+ and had monotypic immunoglobulin (IgM-lambda and IgM-kappa, respectively). Immunostaining on frozen tissue specimens showed that the neoplastic cells or nodules were positive for surface IgM, surface IgD, alkaline phosphatase, and DRC-1. One third to two thirds of the cells were Leu-1+ (CD5+). These results indicated that these cases were primary gastric mantle zone lymphoma. More attention should be paid to primary gastric mantle zone lymphoma because this disease might be erroneously diagnosed as either pseudolymphoma or reactive lymphoid hyperplasia of the stomach.
Multiple sclerosis: histopathologic and MR and/or CT correlation in 37 cases at biopsy and three cases at autopsy. The authors retrospectively reviewed the cases of 40 patients with biopsy- or autopsy-proved inflammatory demyelination consistent with multiple sclerosis (MS); each patient underwent magnetic resonance (MR) and/or computed tomographic (CT) imaging. In review of the 32 MR and 30 CT examinations, three predominant radiologic patterns were apparent: (a) relatively small homogeneous lesions with no or minimal diffuse enhancement; (b) hypoattenuating lesions on CT scans and hypointense lesions on short-TR MR images, with a contrast material-enhanced, isoattenuating or isointense ring; and (c) lesions that were more infiltrative and ill defined, with mixed attenuation and signal intensity and scattered enhancement. A common radiologic feature was lack of mass effect or edema in white matter surrounding even large lesions. In all but four patients the lesions were classified as active by using both histologic and clinical criteria. Histologically active lesions had various radiologic appearances; however, in all contrast-enhanced studies they demonstrated some form of enhancement. Inactive lesions were homogeneously hypoattenuating on CT scans, hypointense on short-TR MR images, and hyperintense on unenhanced, long-TR MR images.
Recognition of gonadotroph adenomas in women BACKGROUND. Pituitary adenomas that arise from the gonadotroph cells are being recognized with increasing frequency in men, but they are still rarely recognized in women. This rarity could be the result of an actual difference in occurrence or of greater difficulty in recognition. The tumors are usually recognized in men more than 50 years old, but elevated serum gonadotropin levels in women of that age could be produced by normal gonadotroph cells. METHODS. Because the stimulation of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and the beta subunit of LH (LH beta) by thyrotropin-releasing hormone (TRH) is a characteristic of gonadotroph adenomas in men, we administered TRH to 16 women with apparently nonsecreting pituitary macroadenomas and measured serum FSH, LH, LH beta, and the glycoprotein hormone alpha subunit every 15 minutes for 90 minutes before and 90 minutes after. The results were compared with the responses in 16 healthy women matched for age and in 10 women with macroadenomas secreting prolactin, growth hormone, or corticotropin. The tumors from 12 of the women with nonsecreting adenomas were cultured, and the secretion of FSH, LH, and LH beta in culture was determined. RESULTS. Eleven of the 16 women with apparently nonsecreting adenomas had significant increases in serum LH beta in response to TRH, 3 had FSH responses, and 4 had LH responses. None of the 16 healthy women and none of the 10 women with secreting macroadenomas had LH beta, FSH, or LH responses to TRH. Ten of the 12 adenomas that were cultured secreted readily detectable amounts of FSH, LH, and LH beta, and their secretion in vitro correlated with the patients' responses to TRH in vivo. CONCLUSIONS. Most apparently nonsecreting pituitary macroadenomas in women arise from gonadotroph cells. The majority of these can be recognized, even in postmenopausal women, by the serum LH beta responses to TRH, and some can be recognized by the responses of serum FSH and LH.
Experimental model of colon cancer: recurrences after surgery alone or associated with intraperitoneal 5-fluorouracil chemotherapy. The liver is the most frequent site of metastases in colon cancer. No good animal model has been available to help improve the treatment of liver metastases or their prevention after resection of a primary colon cancer. The aim of this study was to develop a model of colon cancer induced by azoxymethane in the rat and to study the outcome after surgical resection alone or in association with intraperitoneal chemotherapy (5-fluorouracil (5-FU). Three hundred male Wistar rats received subcutaneous azoxymethane (10 mg/kg body weight/week) for 12 weeks. Eighty-three rats with isolated colon cancer underwent total colectomy; 40 of these rats with no metastases were randomized into two groups: surgery alone or surgery plus 5-FU (5 mg/kg body weight/day) for 5 days after surgery. Thirty rats were able to be evaluated. At autopsy, peritoneal carcinomatosis and liver metastases were more frequent in the control group than after adjuvant treatment with 5-FU (27.7 percent vs. 0, P less than 0.05; and 22.2 percent vs. 0, P less than 0.05, respectively). The rates of peritoneal and hepatic recurrence after resection of the primary cancer indicate that the model mimics the natural history of human colon cancer. In this model, 5-FU reduced the rate of peritoneal carcinomatosis and liver metastases but did not influence survival.
The role of the right hemisphere in emotional communication. Previous research has established that patients with right hemisphere damage (RHD) are impaired in the comprehension of emotional prosody and facial expression. There are several explanations for this impairment. It may reflect defective acoustic and visuospatial analysis, disruption of nonverbal communicative representations, or a disturbance in the comprehension of emotional meaning. In order to examine these hypotheses, we asked RHD patients, left hemisphere damaged patients (LHD) and normal controls (NC) to judge the emotional content of sentences describing nonverbal expressions, and sentences describing emotional situations. We found that RHD subjects performed normally in their ability to infer the emotion conveyed by sentences describing situations. However, RHD patients were impaired in relation to both LHD and NC in the capacity to judge the emotional content of sentences depicting facial, prosodic, and gestural expressions, suggesting a disruption of nonverbal communicative representations.
Inhibition of neutral endopeptidase (EC 3.4.24.11) leads to an atrial natriuretic factor-mediated natriuretic, diuretic and antihypertensive response in rodents. 1. Atrial natriuretic factor is metabolized by neutral endopeptidase (atriopeptidase; EC 3.4.24.11) in vitro. Inhibitors of this enzyme have been reported to prolong the half-life of atrial natriuretic factor in vivo and to potentiate the renal and haemodynamic effects of exogenous atrial natriuretic factor. 2. (+/-)-Candoxatrilat, a selective neutral endopeptidase inhibitor, potentiated the natriuretic and diuretic response to volume loading in anaesthetized rats. Part of the response to volume loading and the potentiation by (+/-)-candoxatrilat was prevented by a polyclonal atrial natriuretic factor antiserum. The diuretic and natriuretic responses evoked by hydrochlorothiazide were not altered by the antiserum. 3. (+/-)-Candoxatrilat reduced systolic blood pressure of one-kidney deoxycorticosterone acetate-salt hypertensive rats for over 5 h. This response was abolished by pretreatment with atrial natriuretic factor antiserum. 4. These data demonstrate that the neutral endopeptidase inhibitor (+/-)-candoxatrilat has natriuretic/diuretic and antihypertensive effects in rodents, and that these effects are mediated via endogenous atrial natriuretic factor.
Clinical use of ultrasound biomicroscopy. The authors have developed a method of obtaining images of cross-sections of the intact anterior globe at microscopic resolution. High-frequency ultrasound transducers (50-100 MHz) have been developed and incorporated into a clinical B-scan device capable of producing images in the living human eye to a depth of approximately 4 mm at an axial and lateral resolution approaching 20 microns. Clinical use of this instrument is no more difficult than conventional immersion ultrasonography. The authors' results in a series of 14 clinical cases have shown that this method can provide information unavailable from any other imaging technique. Anterior segment tumors difficult to define with conventional ultrasound can be measured and the extent of invasion determined. Differentiation of tissue on the basis of internal acoustic characteristics is aided by the very fine backscatter speckle patterns at these frequencies. Pathology behind anterior segment opacities can be imaged in detail and the ability to image angle structures in cross-section allows a new quantitative method of gonioscopy. The ability to define the relationship of the iris, posterior chamber, zonules, ciliary body, and lens is potentially helpful in understanding mechanisms of glaucoma. Ocular structures can be measured with increased accuracy. Clinical ultrasound biomicroscopy (UBM) has shown significant potential as an aid in diagnoses of ocular disease.
Multicenter comparison of once- and twice-daily isradipine to hydrochlorothiazide for the treatment of hypertension in elderly patients. After 8 weeks of isradipine, a twice-a-day dihydropyridine calcium channel blocker, 49% of elderly patients showed a complete response (sitting diastolic blood pressure less than or equal to 85 mm Hg) and 36% showed a partial response (sitting diastolic blood pressure decrease greater than or equal to 10 mm Hg) for an 85% total response rate. Hydrochlorothiazide gave a complete response in 36% of the patients and a partial response in 33%, for a 69% total response rate (p less than 0.0046). Because elderly subjects have reduced clearance for many drugs, we determined how those who responded to twice-a-day administration would respond to once-a-day administration. After 4 weeks of isradipine administered once a day, 54% of the patients showed a complete or partial response, whereas 38% of the patients who were changed to placebo showed a response. In contrast, 82% of patients receiving hydrochlorothiazide once a day showed a response, whereas 60% of patients who were changed to placebo showed a response. These data indicate that the standard formulation of isradipine was not effective when administered once a day.
Tuberculous bronchial stenosis: CT findings in 28 cases. Bronchial stenosis is a complication of tuberculous parenchymal or lymph node disease and may adversely affect its treatment. Findings on plain radiographs may be nonspecific or simulate malignancy. The purpose of this study was to evaluate the role of CT in diagnosing this abnormality. We reviewed the findings in 28 patients who underwent CT to evaluate bronchial stenosis proved by bronchoscopy. Eighteen had evidence of tuberculosis on bronchial biopsy. In the other 10 the biopsy findings were nonspecific, but tuberculous lesions were elsewhere in the thorax. Twelve patients (43%) had CT findings of concentric bronchial stenosis, uniform thickening of the bronchial wall, and involvement of a long segment of the bronchi. In 14 patients (50%), CT showed obliteration of bronchial outlines by adjacent lymphadenopathy, parenchymal consolidation, and absence of intraluminal air. In two patients, the abnormality was not visible on CT. Our experience shows that CT is useful for identifying bronchial stenosis caused by tuberculosis. However, the findings vary, and in more than half of the patients concentric narrowing and uniform thickening of the bronchi are not seen.
Magnetic resonance imaging evaluation of focal computed tomography abnormality in epilepsy. Sixty-seven patients with epilepsy and isolated enhancing computed tomography (CT) scan lesion were studied with magnetic resonance imaging (MRI). Fifty-six patients (83.5%) had partial seizures and 11 (16.4%) had generalized seizures. Four distinct groups were identified by MRI: nonspecific 16 cases (23.8%), tuberculoma 38 cases (56.7%), cysticercosis 12 cases (17.9%), and abscess 1 case (1.4%). Patients in the non-specific group had lesions that were hyperintense on T2 images and hypointense or isointense on T1 images. Such lesions resolved completely in 5 months with serial MRIs while the patients were receiving antiepileptic drugs (AEDs). Virologic studies, including cerebrospinal fluid (CSF) serology, are suggested for patients with such MRI lesions.
Differences in hypertension prevalence among U.S. black and white women of childbearing age. Hypertension and its sequelae complicate pregnancy and can result in poor perinatal outcomes. Overall, U.S. blacks are more likely to be hypertensive than whites, but the degree to which this is true among women of childbearing age (including teenagers) is unknown. Using data from the second National Health and Nutrition Examination Survey (NHANES II), the authors describe hypertension prevalence rates for 422 black and 2,700 white reproductive-age women. The authors present observed data and also predicted prevalence rates derived by modeling the odds of hypertension using logistic regression statistical techniques. They find that black-white differences in hypertension prevalence are negligible among teenagers, but they are pronounced in the older reproductive ages. They estimate that twice the proportion of black women relative to white are hypertensive during pregnancy. Their results suggest that differential rates of hypertension between black and white women may contribute to the persistent excess infant mortality among blacks, but conclusive results cannot be determined from these data. These data are also valuable for the design and evaluation of screening, intervention, and followup programs for hypertensive disease among young women.
Early difference in the endocrine profile of long and short lactational amenorrhea. The endocrine profiles associated with long and short lactational amenorrhea were assessed in a longitudinal study in which morning blood samples were drawn in 48 women from the first postpartum month until the recovery of ovulation and in a cross-sectional study in which the samples were drawn throughout 24 h at the end of the third postpartum month in 10 fully nursing and amenorrheic women. PRL, LH, FSH, estradiol (E2), progesterone, cortisol, and dehydroepiandrosterone sulfate were measured. In both studies we detected a smaller PRL increase in response to suckling (P less than 0.001) and higher E2 levels (P less than 0.001) in nursing women who ovulated within 6 months postpartum compared to those in women who did not. Such differences were observed early after delivery when all women were fully nursing and amenorrheic. These results suggest some probable sources of variability in the duration of lactational amenorrhea in our population. The greater PRL response to suckling associated with longer amenorrhea may be due to higher sensitivity of the breast-hypothalamus-pituitary system or a stronger suckling stimulus in this group. Differences in plasma E2 levels between longer and shorter periods of amenorrhea may reflect dissimilar endogenous production, intake, or clearance of estrogens.
Evaluating quality, cost-effective health care. Vascular database predicated on hospital discharge abstracts. This population-based study examines all carotid endarterectomies (CE) performed by all surgeons in a single state over a 10-year period. The methodology is designed to determine morbidity rate, mortality rate, cost, and length of stay, as well as to understand the effect of pre-existing chronic disease, physician, and hospital volume on these outcome variables. The data source consisted of hospital discharge abstract data uniformly collected on all admissions (N = 5.9 million) to acute care hospitals in the state. In the decade 1979 to 1988, 11,199 patients underwent CE. Mortality rate from CE was 2.1%, and the postoperative stroke rate was 3.7% over this period. High physician volume decreased the mortality rate (p less than 0.05) and stroke rate (p less than 0.01) by 50% and significantly (p less than 0.001) reduced hospital cost and length of stay independent of patient complexity. Examination of cost data, adjusted for inflation, showed a decrease in mean cost for CE over the decade. Thus physicians are providing better care for less hospital dollars. Both patient and payor outcome is improved by concentrating CE patients in the hands of high-volume surgeons. Although the data suggests this trend is already evolving, the pace of this evolution can be expected to increase as payors recognize that regionalization of this procedure lowers costs.
Artificial liver. State of the art. If an effective hepatic assist system existed, it could serve as a bridge to transplantation. Most of the patients waiting for liver transplantation have chronic liver insufficiency but are not in hepatic coma. Various hepatic assist systems have been used to salvage patients with acute liver insufficiency. Most attempts have been disappointing. The methods used have included plasma exchange, plasma adsorption, double filtration, cryofiltration, thermofiltration, the combination of plasma exchange and amino acid hemodialysis, and others. For patients with chronic liver disease with moderate liver function impairment and limited to one or only a few areas of metabolic abnormality, a hepatic assist might allow the life of the patient to be maintained temporarily. The application of hepatic assist methods for chronic liver disease patients treated at the Cleveland Clinic has been encouraging. One of the patients who suffered from sclerosing cholangitis has maintained a near-normal life for almost five years by 170 plasma treatments. This is in spite of the fact that, at the onset of treatment, the patient was nearly comatose. Unfortunately, this patient did not wish to receive a liver transplantation. Based upon this experience, the concept of a bridge to transplantation approach to hepatic assist devices appears feasible. In addition, it is speculated that hepatic assistance during the early recovery stage of liver transplantation and during mild episodes of rejection may be useful.