shukoor65/lab-rag-model huggingface dataset:
Antierythrocyte autoantibody formation after therapy with interleukin-2 and gamma-interferon. The cardiovascular, renal, pulmonary, and dermatologic toxicities of interleukin-2 (IL-2) and gamma-interferon (IFN) are well described. However, autoimmune toxicities have only recently been noticed. The authors report the development of warm autoantibodies against erythrocytes in a patient receiving IL-2 (3.75 x 10(6) cetus units/m2 intravenous bolus three times per week) and gamma-IFN (0.1 mg/m2 subcutaneously three times per week) for metastatic renal cell carcinoma. Other potential causes of autoantibody formation, such as drugs, infection, and collagen vascular disease, were excluded. Both gamma-IFN and IL-2 have the potential to trigger or exacerbate autoimmunity due to either aberrant expression of restricted antigens or inhibition of normal cellular immune suppressor mechanisms.
Elevated thymidine phosphorylase activity in psoriatic lesions accounts for the apparent presence of an epidermal "growth inhibitor," but is not in itself growth inhibitory. An apparent tissue-specific growth inhibitor, or chalone, obtained from psoriatic lesions was tentatively identified in the 100-kDa fraction based upon inhibition of DNA synthesis, as measured by [3H]-thymidine uptake by a squamous cell carcinoma cell line, SCC 38. This fraction, however, failed to inhibit SCC 38 cell growth when assessed directly in a neutral red uptake assay. Characterization of the inhibitor of [3H]-thymidine uptake revealed it to have biochemical properties identical to thymidine phosphorylase: 1) molecular weight close to 100 kDa, 2) isoelectric point of 4.2, and 3) thymidine phosphorylase enzyme activity. Thus, we conclude that its ability to inhibit [3H]-thymidine uptake was due to thymidine catabolism rather than inhibition of DNA synthesis or growth inhibition. Examination of thymidine phosphorylase activity in keratome biopsies from psoriatic and normal skin demonstrated a twentyfold increase in activity in psoriatic lesions relative to non-lesional or normal skin. This increase in metabolism of thymidine was due to thymidine phosphorylase rather than uridine phosphorylase activity. The correlation between increased thymidine phosphorylase activity and increased keratinocyte proliferation in vitro (cultured) and in vivo (psoriasis), suggests that this enzyme may play a critical role in providing the thymidine necessary for keratinocyte proliferation.
Blood platelet count and function are related to total and cardiovascular death in apparently healthy men BACKGROUND. Experimental animal and clinical studies indicate that blood platelets have an important role in atherosclerosis and formation of thrombi. Prospective studies presenting evidence of an association between blood platelet count and cardiovascular mortality have not been performed. METHODS AND RESULTS. From 1973 to 1975, blood platelets were counted, and their responsiveness to aggregating agents was studied in healthy middle-aged men. The aim was to assess the possible association between these variables and coronary heart disease. At 13.5 years of follow up, a significantly higher coronary heart disease mortality was observed among the 25% of subjects with the highest platelet counts. Platelet aggregation performed in a random subsample (150 of the 487 men), moreover, revealed that the 50% with the most rapid aggregation response after ADP stimulation had significantly increased coronary heart disease mortality compared with the others. These associations could not be explained by differences in age, lipids, blood pressure, or smoking habits. CONCLUSIONS. The present study is the first to present conclusive, prospective evidence of an association between platelet concentration and aggregability and long-term incidence of fatal coronary heart disease in a population of apparently healthy middle-aged men.
Interaction of chemical and mechanical respiratory stimuli in the arousal response to hypoxia in sleeping dogs. The role of respiratory mechanoreceptor stimuli in the arousal response to hypoxia was studied in three trained dogs. The dogs breathed through a cuffed endotracheal tube inserted through a chronic tracheostomy, and resistive loads of 8 to 49 cm H2O/L/s were added to the expiratory circuit. Arterial O2 saturation (SaO2) was measured with an ear oximeter, and isocapnic progressive hypoxia was induced by a rebreathing technique. Arousal from sleep was determined by electroencephalographic and behavioral criteria. SaO2 at arousal from non-rapid eye movement (NREM) sleep increased progressively from 67.5 +/- 4.6% (mean +/- SEM), with no added resistance to 85.2 +/- 0.5% with the highest resistance (p less than 0.01), and from 60.6 +/- 0.6 to 81.6 +/- 0.4% during REM sleep (p less than 0.01). The added resistances also increased the steady-state (normoxic) level of alveolar PCO2 (PACO2). However, when PACO2 was increased to comparable levels by the addition of dead space rather than expiratory resistance to the breathing circuit, SaO2 at arousal from hypoxia was significantly lower than during expiratory resistive loading (p less than 0.05). We therefore conclude that mechanoreceptor stimuli arising from the ventilatory apparatus may contribute substantially to the arousal response to hypoxia.
Response of obstructive sleep apnea to fluoxetine and protriptyline. Protripyline is the pharmacologic agent most commonly used to treat obstructive sleep apnea (OSA); however, its anticholinergic side effects make it intolerable to many patients. Because serotonin may be a central respiratory stimulant and because the serotonin-uptake inhibitor, fluoxetine, is usually well tolerated, we wanted to try fluoxetine in the treatment of OSA. Therefore, we compared the effect of fluoxetine to that of protriptyline in 12 patients with OSA. Both drugs significantly decreased the proportion of REM sleep time and decreased the number of apneas or hypopneas in NREM sleep. The response to fluoxetine was equivalent to that of protriptyline; however, for the group as a whole, there was no significant improvement in the number of arterial oxygen desaturation events, the level of arterial oxygen desaturation, or the number of arousals with either agent. Although there was wide variability in the response to each medication, six of the 12 patients had good responses, including improvement in oxygenation, to either fluoxetine or protriptyline. Three patients could not complete the trial of protriptyline. We conclude that fluoxetine is beneficial to some, but not all, patients with OSA. Fluoxetine was better tolerated than protriptyline.
Punctal occlusion and blepharoplasty in patients with dry eye syndrome. Blepharoplasty and inferior punctal occlusion were performed on 24 consecutive patients with dry eye syndrome. Fifteen patients (62.5%) had symptomatic dry eye syndrome preoperatively and nine patients (37.5%) had asymptomatic dry eye syndrome diagnosed during the preoperative workup (subclinical dry eye syndrome). After surgery, nine patients (37.5%) had improvement of their dry eye syndrome, 10 patients (42%) were unchanged, and two patients (8%) had worsening of their dry eye syndrome. A third patient had worsening of the dry eye syndrome 6 months postoperatively when her puncta reopened. Two patients (8%) had increased irritation only when wearing contact lenses, but in one patient this resolved 6 months after surgery. Thus, although a significant number are improved, a few patients will have worsening of dry eye syndrome after blepharoplasty and inferior punctal occlusion.
Serum iron and neuroleptic malignant syndrome. Neuroleptic malignant syndrome (NMS) is a fulminant, life-threatening reaction to neuroleptic medications. The only consistently described biochemical abnormalities are increased creatine kinase and leucocytosis. Because of a possible association between NMS and dopaminergic function and between serum iron and dopaminergic function, we prospectively measured serum iron in 26 episodes of NMS in twenty-three patients. In 25 episodes (96%) serum iron concentration was 10 mumol/l or lower--more than 2 SD below the mean normal value. Serum iron in 11 episodes (36%) was 4 mumol/l or lower. In each episode for which data are available, serum iron returned to normal upon resolution of the NMS. Serum iron may be a helpful adjunct for the diagnosis of the disorder. The pronounced reduction in serum iron suggests that the acute phase reaction may have a role in NMS.
Who benefits from a pediatric home care program? Earlier reports of a randomized controlled trial of the Pediatric Home Care (PHC) program for children with chronic physical illness demonstrated overall benefits for the group enrolled in the PHC program. This paper examines which subgroups benefited most (relative to control subjects) and which benefited least from the PHC intervention. Prior to the randomized controlled trial, PHC served those with the most burdensome medical conditions from the families with the fewest coping resources. However, data from the randomized controlled trial (N = 219) show that these were not the subjects who benefited most. Maximal benefit was evident when illness burden was small, but coping resources were low (social, educational, financial, and personal). Analyses of covariance show that subjects in PHC with both low burden and low resources had consistently better outcomes than similar subjects in Standard Care. When the illness burden was similarly low, but resources were more abundant, those in Standard Care appear to have had better outcomes than those in PHC. For those whose illness burden was more severe, the results were mixed. These findings suggest that the conventional priority of allocating existing intervention resources to the medically most burdensome cases may not always be maximally beneficial. Those with less burdensome conditions may derive greater benefit relative to control subjects from an intervention than those with extreme needs. Both medical and social factors should enter into the decision regarding the allocation of scarce resources.
A rare complication of mitral valve replacement. Intraoperative fracture of the right fibrous trigone following a superior approach to the left atrium. Case report. A rare complication of mitral valve replacement is reported. Following a superior approach, through the roof of the left atrium the mitral valve was replaced with a Bjork-Shiley prosthesis in a 52-year-old female, who had undergone previous closed commissurotomy. Fracture of the right fibrous trigone occurred at surgery, following the completion of mitral valve replacement. The lesion was successfully repaired on cardiopulmonary bypass under cardioplegic arrest, placing sutures, after an oblique aortotomy, from below the noncoronary aortic cusp. The postoperative course was uneventful, without occurrence of a-v block. We believe that a superior approach to the left atrium may be a valid alternative for mitral valve surgery in some selected cases.
Comparison of morphine and methadone for prevention of postoperative pain in 3- to 7-year-old children. A randomized, double-blind, prospective study was performed to determine the effects of perioperative administration of morphine or methadone on postoperative analgesic requirements and pain scores in 35 children aged 3 to 7 years undergoing major surgery. After a standardized induction of anesthesia, methadone or morphine, 0.2 mg/kg, was blindly administered, and supplemental doses were titrated to achieve comfort in the recovery room. Pain was assessed during the next 36 hours with a combination of validated behavioral and self-report measures. Patients in the methadone group required fewer supplemental opioid analgesic drugs during the next 36 hours, and reported lower pain scores. No patient had prolonged emergence from anesthesia, and no patient required naloxone or postoperative ventilatory assistance. No major adverse events occurred. We conclude that perioperative intravenous administration of methadone is an effective, inexpensive, and technologically simple means for providing prolonged analgesia for children after surgery.
Self-expandable stainless steel endoprostheses for treatment of malignant bile duct obstruction. The Wallstent biliary endoprosthesis is a mesh of stainless steel that is delivered percutaneously over a 7-French catheter but expands to achieve a 1-cm lumen when released across a bile-duct stricture. The small transhepatic track required makes insertion easier, less painful, and probably safer when compared with plastic stents, and the large internal lumen reduces the rate of occlusion by encrusted bile. Wallstent endoprostheses were inserted under local anesthesia in 41 consecutive patients with malignant obstructive jaundice. Biliary drainage was considered the treatment of choice in all of these patients. The diagnosis was based on biopsy results in 32 patients and on radiologic appearances in nine. The patients were followed up in outpatient clinics for 16 months and had repeated radiologic examinations only if they had symptoms suggesting stent occlusion. No cases of hemobilia due to damaged hepatic vessels occurred. Two patients had septicemia treated with antibiotics. Three patients had recurrent jaundice due to growth of tumor below or above the stents. Endoprosthesis migration was not seen. No cases of stent occlusion due to encrustation of bile occurred. The median survival of patients was 105 days (range, 10-545 days). Our experience shows that Wallstent endoprostheses can be inserted with little discomfort for the patient and with relatively few complications. They provide good palliation in patients with malignant obstructive jaundice.
Distribution patterns of type VII collagen in normal and malignant human tissues. The distribution of basement membrane type VII collagen was detected immunohistochemically and compared in normal human organs and their neoplastic derivatives using monoclonal antibody LH7.2. In normal tissues, type VII collagen was found to be restricted to the basement membrane surrounding or underlying combined epithelia, such as those lining breast, prostate, and bronchus, which are composed of a basal and luminal cell layer, and stratified epithelia, such as larynx, esophagus, trachea, vagina, ectocervix, and epidermis. No type VII collagen was found in the "simple' epithelia lining the major part of the gastrointestinal tract (GI) tract, such as liver, stomach, and intestine, or around blood vessels, muscle, and nerve fibers, which are surrounded, however, by a basement membrane containing type IV collagen and laminin. When tested in benign and malignant local tumors, antibody LH7.2 showed staining patterns partly similar to those observed in the corresponding normal tissues. This resulted in a well-circumscribed positive reaction around ducts in carcinomas in situ of the breast, in benign prostate tumors, in pleomorphic adenomas, and in a negative reaction in tumors of the GI tract. Furthermore type VII collagen was predominantly seen in carcinomas with a squamous differentiation, such as squamous carcinomas of the lung, head and neck, vulva, and vagina. These results indicate that the presence of type VII collagen in malignant tumors is correlated with (squamous) differentiation rather than with the origin of the tumor. With tumor progression, an increased presence of type VII collagen, as compared with normal urinary bladder, was found in infiltrating transitional cell carcinomas. Thus, although in general invasive and metastatic tumors do not express extensively type VII collagen, exceptions to this rule exist in bladder cancer, squamous carcinomas of the lung, tumors of the head and neck region, female genital tract tumors, and in some adenocarcinomas of the breast.
Left ventricular shape as a determinant of functional mitral regurgitation in patients with severe heart failure secondary to either coronary artery disease or idiopathic dilated cardiomyopathy. The relation between left ventricular (LV) shape and functional mitral regurgitation (MR) was evaluated in 39 patients with congestive heart failure. Heart failure was due to coronary artery disease in 23 patients (group I) and to idiopathic dilated cardiomyopathy in 16 (group II). LV shape was quantitated based on the ratio of LV major-to-minor axis and LV sphericity index calculated at end-systole and end-diastole. In group I, 9 patients had angiographic evidence of MR and 14 did not. In group II, 10 patients had MR and 6 did not. Within each group, there were no differences between patients with and without MR with regard to LV chamber volume and regional segmental wall motion abnormalities. In both groups, however, a significant difference was observed between patients with and without MR with respect to end-systolic and end-diastolic LV shape indexes. In group I, the end-systolic major-to-minor axis ratio was lower in patients with (1.42 +/- 0.04) than without (1.72 +/- 0.05) MR (p less than 0.001). Similar differences were observed in group II (1.41 +/- 0.06 vs 1.69 +/- 0.04) (p less than 0.01). In group I, the end-systolic sphericity index was also greater in patients with (0.32 +/- 0.02) than without (0.25 +/- 0.01) MR (p less than 0.02). Similar differences were observed in group II (0.37 +/- 0.03 vs 0.26 +/- 0.01) (p less than 0.02). These data indicate that in patients with severe heart failure, functional MR is present in those who manifest a more spherical LV cavity.
IFN-gamma differentially modulates the susceptibility of L1210 and P815 tumor targets for macrophage-mediated cytotoxicity. Role of macrophage-target interaction coupled to nitric oxide generation, but independent of tumor necrosis factor production. IFN-gamma primes murine macrophages to render them responsive for triggering by subactivating concentrations of bacterial LPS to mediate nonspecific tumor cytotoxicity. However, IFN-gamma also has direct anti-proliferative effects on transformed cells that serve as sensitive tumor targets for cytotoxic macrophages. We investigated the effects of preexposure of L1210 mouse leukemia and P815 mouse mastocytoma targets to rIFN-gamma on changes in their susceptibility to cytotoxicity by LPS-activated mouse peritoneal macrophages (PM). Co-incubation of inflammatory PM and either L1210 or P815 targets with IFN-gamma and LPS produced a classical synergistic cytotoxicity for both targets over that of IFN-gamma or LPS alone. Similar synergistic augmentation of cytotoxicity occurred when effector PM were preprimed for 24 h with IFN-gamma before testing for cytotoxicity of untreated targets. However, pretreatment of L1210 and P815 targets for 24 h with IFN-gamma (50 U) before assay produced divergent results in that L1210 was more susceptible, whereas P815 was less susceptible to cytotoxicity by LPS-activated macrophages. Similar results were obtained when both macrophages and targets were pretreated separately with IFN-gamma for 24 h before their combined assay for tumor cytotoxicity. Pretreatment of L1210 targets for 1, 4, or 24 h with IFN-gamma produced similar effects on their increased susceptibility to macrophage cytotoxicity. In contrast, P815 pretreated for 1 and 4 h with IFN-gamma showed an early increased susceptibility to macrophage cytotoxicity followed by a decrease after 24 h pretreatment. The pretreatment of L1210 or P815 targets with IFN-gamma before their exposure to LPS-activated macrophages had no effect on the production of TNF. However, there was a corresponding increase in nitric oxide generation by LPS-activated macrophages after their exposure to IFN-gamma pretreated L1210 targets and a decrease in the presence of IFN-gamma-pretreated P815 targets that correlated with their changes in susceptibility to macrophage killing. Nitric oxide generation by macrophages alone in response to LPS was found to be greater than when effector macrophages were exposed to the tumor targets and this was either increased by L1210 or decreased by P815 that had been pretreated with IFN-gamma. Our results indicate that IFN-gamma may act directly and differentially on tumor targets to alter their susceptibility for macrophage cytotoxicity, which was coupled to changes in the generation of cytotoxic nitric oxide, rather than TNF production by the macrophage.(ABSTRACT TRUNCATED AT 400 WORDS).
Chemical meningism after lumbar facet joint block with local anaesthetic and steroids. A case is reported in which chemical meningism occurred after lumbar facet joint block with methylprednisolone acetate and bupivacaine. This complication was probably due to inadvertent dural puncture. The use of steroids in facet joint injections is questioned.
Clinical characteristics of nonfatal myocardial infarction among individuals on prophylactic low-dose aspirin therapy. BACKGROUND. The influence of prophylactic low-dose aspirin on the clinical characteristics of subsequent nonfatal myocardial infarction was examined in the Physicians' Health Study, a randomized, double-blind placebo-controlled trial of alternate-day aspirin (325 mg) among 22,071 US male physicians. METHODS AND RESULTS. During 60.2 months of follow-up, 342 incident cases of nonfatal myocardial infarction were confirmed (95.2% of all reports): 129 on aspirin and 213 on placebo (p less than 0.00001). Despite this statistically extreme reduction in occurrence of a first nonfatal infarction attributable to aspirin, there were no significant differences in the size, location, electrocardiographic features, or postinfarction left ventricular ejection fraction between the aspirin and placebo groups. Furthermore, among those undergoing angiography, there were no differences in the distribution or number of coronary vessels obstructed. CONCLUSIONS. These data indicate that chronic platelet inhibition with alternate-day aspirin therapy reduces the risk of a first myocardial infarction but does not appear to have a significant effect on the clinical characteristics of events that are survived. This finding may result from a direct effect of aspirin or from an aspirin-induced shift in infarction severity. Regardless of mechanism, these clinical observations suggest that treatment decisions for acute infarction patients should be made independently of a history of aspirin use.
Basic hearing tests. This article contains a discussion of pure-tone and speech audiometry as these measures relate to primary audiologic evaluation of hearing. The scientific foundation underlying the development of stimulus-specific standards for normal hearing, test materials, and methods for basic tests are included. A rationale for test administration, masking, and interpretation of results is presented.
Sarcoidosis presenting as an isolated intramedullary tumor. We report a case of isolated intramedullary sarcoidosis. The patient developed progressive signs that indicated a spinal tumor, which were investigated with contrast-enhanced magnetic resonance imaging scans. Magnetic resonance imaging clearly revealed an intramedullary lesion, but the diagnosis of sarcoidosis was made on the pathological analysis of the surgical specimen. Magnetic resonance imaging with contrast enhancement is reported in a histologically proven case of intramedullary sarcoidosis. Only 12 other cases of isolated intramedullary sarcoidosis have been reported. We review and discuss these cases according to their clinical presentation, the segmental location of the granulomas in the spinal cord, preoperative and operative diagnoses, and signs for systemic sarcoidosis. In none of the cases was the diagnosis of intramedullary sarcoidosis made before surgery. We think that surgical therapy for intramedullary lesions is the best way to diagnose rare instances of benign lesions like sarcoidosis and to treat them in an appropriate manner.