shukoor65/lab-rag-model huggingface dataset:
Cardiac involvement in patients with primary antiphospholipid syndrome. To evaluate cardiac involvement in primary antiphospholipid syndrome, two-dimensional and Doppler echocardiographic studies were performed in 34 consecutive patients with this syndrome. All patients had an increased level of serum anticardiolipin antibodies with no evidence of malignancy or systemic lupus erythematosus. The clinical manifestations of primary antiphospholipid syndrome were arterial thrombosis in 14 patients, venous thrombosis in 6 and recurrent fetal loss in 14. Valvular lesions were observed on two-dimensional echocardiography in 11 patients (32%) (9 women and 2 men), aged 24 to 57 years (mean +/- 1 SD 36 +/- 10). Abnormal echocardiographic findings were observed in 9 (64%) of 14 patients with arterial thrombosis versus 1 (17%) of 6 patients with venous thrombosis and 1 (7%) of 14 patients with recurrent fetal loss. The most common echocardiographic abnormality was mitral leaflet thickening, found in five patients; this was associated with mitral regurgitation in three and with combined mild mitral stenosis and regurgitation in one patient. Localized subvalvular mitral thickening was observed in one patient and calcification of the anulus in another. Aortic valve thickening was observed in two patients, one of whom also had a moderate degree of aortic regurgitation. Vegetation-like lesions on the mitral or aortic valve were found in two patients. It is concluded that valvular lesions are commonly found in primary antiphospholipid syndrome, particularly when the syndrome is manifested by peripheral arterial thrombosis. The location and appearance of valvular lesions in this syndrome are heterogeneous. Most patients have no clinically significant valvular disease. Two-dimensional and Doppler echocardiographic studies are often informative in these patients.
Cerebral akinetopsia (visual motion blindness). A review. Cerebral akinetopsia is a syndrome in which a patient loses specifically the ability to perceive visual motion following cortical lesions outside the striate cortex. There has been only one good case of akinetopsia in the published literature. Yet that case was immediately accepted by the neurological world. In this, cerebral akinetopsia differs markedly from cerebral achromatopsia, the evidence for which was strongly contested for the better part of a century (Zeki, 1990). This article complements the one on cerebral achromatopsia, traces the history of akinetopsia and enquires into why it was so much more readily acceptable than achromatopsia.
Normalisation of refractive error after steroid injection for adnexal haemangiomas. A longitudinal study of 27 patients with infantile haemangiomas is reported. It confirmed the efficacy of local steroid injection as a method of treatment; 81.5% of patients showed a marked improvement, with the lesion reducing to 25% or less of its original size. Involution was most marked in the first two weeks but continued for up to four months after injection. Amblyopia was present in 43% of children and was usually the result of induced refractive error rather than obstruction of the visual axis or strabismus. Anisometropia was found in 68% of children, with a high incidence of asymmetric astigmatism on the side of the haemangioma. Following local steroid injection a marked reduction in astigmatism was noted in 53.8% of children, a lesser reduction in 15.4%, and no reduction in 30.8%. Successful treatment of the haemangioma, therefore, may not remove the risk of amblyopia, and regular refraction and visual assessment remain mandatory.
Association of postoperative apnea, airway obstruction, and hypoxemia in former premature infants. Airway obstruction plays an important role in the pathogenesis of apnea in premature infants who have not previously undergone anesthesia. To determine the role of airway obstruction in postoperative apnea, we studied 74 former premature infants by integrated recordings of nasal airflow, pneumocardiography, and pulse oximetry during the initial 2 h of recovery from inhalational anesthesia. Apnea (greater than 6 s) was classified as central, obstructive, or mixed, wherein mixed apnea consisted of central and obstructive apnea within the same apneic episode. Postoperative apnea was observed in 23 infants, ranging in age from 31-48 weeks postconception: 12 had inguinal herniorrhaphy (hernia group) and 11 had other procedures (other group). Of the 268 apneic episodes in the hernia group, 73% were central, 6% obstructive, and 21% mixed. Infants in the other group had 505 apneic episodes, with a distribution nearly identical to that in the hernia group. Central and mixed apnea occurred in all infants experiencing apnea, except in 1 infant, who had only central apnea, whereas obstructive apnea occurred in only one third of the apneic infants. Arterial hemoglobin desaturation was significantly more frequent at the end of mixed and obstructive apnea than after central apnea (P less than 0.01). In both groups, arterial hemoglobin O2 saturation (SpO2) decreased to less than 80% in approximately 35% of mixed and obstructive apneic episodes, compared to approximately 5% of central apneic episodes. SpO2 remained greater than or equal to 90% in over 80% of central apneic episodes, compared to 40% of mixed and obstructive apneic episodes.
Combined portal vein and liver resection for carcinoma of the biliary tract. Twenty-nine patients with advanced carcinoma of the bile duct or gallbladder underwent combined portal vein and liver resection. Segmental excision of the portal vein was performed in 16 cases and wedge resection of the vessel wall in 13. The operative mortality rate was 17 per cent. The median survival for the 24 patients who left hospital was 19.8 months. Actuarial survival rates at 1, 3 and 5 years for all 29 patients were 48 per cent, 29 per cent, and 6 per cent respectively, whereas the median survival for 46 patients with unresectable carcinoma was 3 months and the 1 and 3-year actuarial survival rates were 13 per cent and zero respectively. This difference in survival times between patients undergoing hepatectomy with portal vein resection and those with unresectable carcinoma were statistically significant (P less than 0.01). Combined portal vein and liver resection is recommended as a reasonable surgical approach in selected patients with advanced carcinoma of the biliary tract.
A reappraisal of the coelomic metaplasia theory by reviewing endometriosis occurring in unusual sites and instances. Endometriosis occurring in unusual sites and instances was reviewed for the purpose of exploring the pathogenesis of the disease. Endometriosis is frequently observed in the pelves of menstruating women. It occurs in teenagers even before menarche, in women who have never menstruated, and in postmenopausal women. It affects not only the pelvic organs but also the right-sided thoracic organs and rarely the extremities. It occurs in men who are castrated and treated with estrogen. The affected sites in both common and uncommon endometriosis include cells arising from the coelomic membrane and sites exposed to metaplasia-inducing substances such as estrogen and unknown factors liberated from the degenerating endometrium. This appears to strengthen the coelomic metaplasia theory, although additional basic and experimental data must still be accumulated to confirm this theory.
Herpes zoster myelitis. We studied the clinical (10 patients) and pathological (9 patients) findings in 13 patients with herpes zoster myelitis, all of whom had systemic illnesses associated with immunosuppression. The median interval between the onset of the herpes zoster rash and myelopathic symptoms was 12 days, and the subsequent median interval to maximal deficit was 10.5 days. Presenting neurological symptoms were characteristically ipsilateral to the rash, with motor dysfunction predominating, followed by a spinothalamic and, less often, posterior column sensory deficit. Pathological involvement was most severe in the dorsal root entry zone and posterior horn of the spinal cord segment corresponding to the involved dermatome. There was variable spread both horizontally and vertically in the spinal cord. Direct varicella-zoster virus (VZV) infection of neuroectodermal cells, particularly oligodendrocytes, was demonstrated by immunostaining viral antigens (8 cases), and by the presence of Cowdry type A intranuclear inclusions (7 cases) and often was associated with focal demyelination (6 cases). In 4 patients a VZV vasculitis was associated with leptomeningitis and haemorrhagic necrosis (spinal cord in 1; brainstem or cerebellum in 3). The protracted evolution in many cases and the pathologically documented direct viral infection of the spinal cord provide a rational basis for the use of antiviral therapy in preventing or attenuating the evolving myelopathy.
HLA association with dermatitis herpetiformis is accounted for by a cis or transassociated DQ heterodimer. HLA-DR, DQ, and DP restriction fragment genotyping was undertaken in 23 dermatitis herpetiformis patients and 53 healthy control subjects. HLA-DQw2 was present in 100% of patients with dermatitis herpetiformis (23 of 23) versus 40% of control subjects (21 of 53). Significant secondary associations occurred with HLA-DR3 (91% of patients versus 28% of control subjects) and DPw1 (39% of patients versus 11% of control subjects). Dermatitis herpetiformis and coeliac disease thus share an identical HLA class II association. It is likely that HLA class II genes directly influence the immune responses leading to mucosal damage in both diseases. The strongest candidate for disease susceptibility to dermatitis herpetiformis is DQw2. The HLA molecule most likely to be involved in coeliac disease is a specific DQ alpha/DQ beta heterodimer, encoded in cis arrangement in DR3 haplotypes or in trans arrangement in a DR5, 7 genotype. Our data on dermatitis herpetiformis patients fits this model perfectly. All these patients are capable of expressing this molecule, which may be responsible for the gluten sensitive enteropathy seen in a subgroup of patients with dermatitis herpetiformis and coeliac disease.
Sequences of taxol and cisplatin: a phase I and pharmacologic study. Untreated and minimally pretreated solid tumor patients received alternating sequences of taxol and cisplatin. Sequential dose escalation of each agent using taxol doses of 110 or 135 mg/m2 and cisplatin doses of 50 or 75 mg/m2 resulted in four dosage permutations that induced grades 3 and 4 neutropenia in 72% to 84% and 50% to 53% of courses, respectively. Neutropenia was brief, and hospitalization for neutropenia and fever was required in 13% to 24% of courses. However, further escalation of taxol to 170 or 200 mg/m2 induced grade 4 neutropenia in 79% to 82% of courses. At the highest taxol-cisplatin dose level (200 mg/m2 to 75 mg/m2), the mean neutrophil count nadir was 98/microL, and hospitalization for neutropenia and fever was required in 64% of courses. The sequence of cisplatin before taxol, which has less antitumor activity in vitro, induced more profound neutropenia than the alternate sequence. Pharmacologic studies indicated that this difference was probably due to 25% lower taxol clearance rates when cisplatin preceded taxol. Although neurotoxicity was initially thought to be a potentially serious effect of the combination, mild to modest neurotoxicity occurred in only 27% of patients. Adverse effects also included myalgias, alopecia, vomiting, diarrhea, bradycardia, and asymptomatic ventricular tachycardia. Objective responses were noted in melanoma, as well as non-small-cell lung, ovarian, breast, head and neck, colon, and pancreatic carcinomas. Based on these results, the sequence of taxol before cisplatin at doses of 135 and 75 mg/m2, respectively, is recommended for phase II/III trials, with escalation of taxol to 170 mg/m2 if treatment is well tolerated.
Nosocomial pneumonia in the critically ill: product of aspiration or translocation? OBJECTIVE: To examine the possibility that nosocomial pneumonias might be caused by the translocation of enteric bacteria and their toxins. DESIGN: Prospectively collected previous database was examined by logistic regression analysis. SETTING: University medical center. PATIENTS: Sixty-two ICU patients. MEASUREMENTS AND MAIN RESULTS: The best stand-alone predictors for nosocomial pneumonia were bleeding from stress ulceration (p less than .001), the severity of illness present (p less than .001), and intramucosal acidosis in the stomach (p = .023), a metabolic indication of mucosal ischemia. Mechanical ventilation (p = .038) and the administration of antacids/cimetidine (p = .054) were also of stand-alone predictive value, but did not significantly improve the best predictive model for nosocomial pneumonia derived from the severity of illness present and the intramucosal pH in the stomach. CONCLUSIONS: The findings are consistent with the hypothesis that ischemic mucosal injury and its associated translocation of enteric bacteria and toxins might be more important in the pathogenesis of nosocomial pneumonia in the critically ill than the aspiration of contaminated nasopharyngeal secretions.
Intrathecal morphine for postoperative analgesia in children after selective dorsal root rhizotomy. The authors report their experience with low doses (0.007-0.015 mg/kg), moderate doses (0.016-0.025 mg/kg), and high doses (0.026-0.035 mg/kg) of intrathecal morphine for postoperative analgesia after selective dorsal root rhizotomy surgery in 50 children, aged 3 to 12 years. After closure of the dura, a single dose of preservative-free morphine was injected into the subarachnoid space, and patients were assessed for 48 hours for level of comfort and side effects. The three doses of morphine provided equivalent analgesia and similar side effects. The duration of postoperative analgesia ranged from 3 to 48 hours (mean, 12.2 +/- 9.5 h). Common side effects were limited to nausea and vomiting (42%) and mild facial pruritus. No patient experienced late respiratory depression or generalized pruritus. The authors conclude that low doses of intrathecal morphine is as effective as moderate or high doses of morphine for reducing pain in the immediate postoperative period. Intrathecal morphine provides excellent analgesia after selective dorsal rhizotomy.
Hypopituitarism. The pituitary regulates the body's endocrine system, including the thyroid gland, adrenal cortex, ovaries and testes, through the release of numerous hormones. Pituitary function, in turn, is regulated through complex feedback loops involving the hypothalamus and the target endocrine glands. Hypopituitarism may result from multiple causes, including primary and metastatic cancer, ischemic and granulomatous disease, infection, developmental abnormalities and trauma, which may affect the gland itself (primary hypopituitarism) or the hypothalamus (secondary hypopituitarism). Depending on the anatomic lesion, patients with hypopituitarism may present with signs or symptoms of multiple endocrine abnormalities, such as hypothyroidism, adrenal insufficiency, diabetes insipidus, hypoglycemia, sexual dysfunction and growth retardation. A thorough clinical history, detailed examination, laboratory evaluation of endocrine function and radiographic views of the pituitary and sella turcica can suggest the diagnosis and etiology. Treatment, usually lifelong, may include hormone replacement and medical or surgical correction of the underlying disease.
Lithotripsy versus cholecystectomy for management of gallstones. A decision analysis by Markov process. Extracorporeal shock-wave lithotripsy is a new treatment method that effectively distintegrates radiolucent gallstones and is associated with a low complication rate. Using the model of a Markov process for decision analysis, survival and costs under four possible strategies to treat gallstones were compared: expectant management with cholecystectomy (EC) or lithotripsy (EL) reserved for symptomatic gallstones; prophylactic cholecystectomy (PC) or lithotripsy (PL) for all gallstones. Life expectancy for the different strategies varies by few days. Only if high annual rates of pain and complication occurred in subjects with silent gallstones would both prophylactic procedures marginally increase life expectancy. Prophylactic cholecystectomy then would be more cost-effective than prophylactic lithotripsy. Expectant strategies remain much cheaper than prophylactic management over a broad range of probability values and procedural costs. Expectant use of lithotripsy costs less than cholecystectomy. A low success rate of lithotripsy would raise the direct costs of lithotripsy above those of cholecystectomy but leave total costs of both strategies in the same order of magnitude. Lithotripsy appears to be a feasible alternative to treat symptomatic but not asymptomatic gallstones.
Urinary retention after pyeloplasty. A retrospective review of 37 pyeloplasties, performed between 1984 and 1988, revealed that 38% of patients had post-operative retention requiring catheterisation, compared with 8% in an age and sex matched group of patients undergoing cholecystectomy. This suggests that direct surgical trauma to the upper genitourinary system may inhibit bladder function. We therefore suggest that pre-operative catheterisation should be considered in theatre, for patients undergoing pyeloplasty.
Fatal pulmonary aspergillosis presenting as acute eosinophilic pneumonia in a previously healthy child. A previously healthy boy presented with cough and diffuse pulmonary interstitial infiltrates. Acute eosinophilic pneumonia was diagnosed by bronchoalveolar lavage in the absence of a demonstrable infectious etiologic agent. Corticosteroid therapy resulted in immediate improvement but was followed by respiratory distress and death from invasive aspergillosis and Pseudomonas cepacia sepsis.
Otolaryngology problems in the immune compromised patient--an evolving natural history. As the human immunodeficiency virus is being detected in increasing numbers of asymptomatic individuals at risk, newer earlier patterns of disease have become apparent--including cranial and cervical herpes zoster, oral hairy leukoplakia, and oral candidiasis--thus linking viral and other disease to the development of acquired immunodeficiency disease (AIDS). Many similarities between patients with AIDS and other immunosuppressed patients have emerged. As immunosuppressed patients survive longer, they begin to manifest cancers such as lymphomas and squamous cell cancers in addition to Kaposi's sarcoma. Otolaryngologists can learn to identify and treat otitis and sinusitis in the immunosuppressed patient, to identify predictive early signs such as oral hairy leukoplakia, herpes simplex virus, and oral candidiasis, and to diagnose and treat Kaposi's sarcomas of the head and neck, lymphomas, squamous cell cancers, and opportunistic infections as the immunodeficiency disease progresses.
The expression of proliferative-associated nuclear antigen p105 in gastric carcinoma. The expression of proliferation-associated nuclear antigen p105 of gastric carcinomas was studied by multiparameter flow cytometric and immunohistochemical technique. Multiparameter flow cytometric analysis revealed that p105 expression was rarely observed in the resting cells of normal gastric epithelium. On the contrary, the immunofluorescence (IF) intensity of cancer cells in G1 phase was approximately two-fold to three-fold greater than that of G0 phase of cancer cells or normal gastric epithelium. The p105 antigen content of cancer cells increased with cell cycle progression, and increased more rapidly in cells in late S-phase than in cells in G0 and early S-phase. Microphotometric study demonstrated that cells in M-phase exhibited a dramatic increase in the amount of the antigen, and the IF intensity of the mitotic cells were approximately five-fold to ten-fold greater than that of cells in G1 and S-phase. These results indicate that the antigen demonstrated by the p105 monoclonal antibody is present in the G1, S, G2, M-phases, but not in the G0 phase. Immunohistochemical technique demonstrated that patients with lymph node metastases are more likely to have high p105-positive rates than did node-negative patients. The mean p105-positive rates of aneuploid tumors was significantly higher than those of diploid tumors. From these results the authors speculate that the measurement of p105-positive rates may be a powerful prognostic indicator of gastric carcinoma.
Anterior capsule adherence to iris leading to pseudophakic pupillary block. We present a rare case of anterior capsule adherence to the iris following extracapsular cataract extraction with posterior chamber intraocular lens implantation and leading to pseudophakic pupillary block. There were no synechiae at the pupillary margins associated with the capsule/iris adherence, but aqueous was entrapped behind the iris and intraocular pressure rose. Laser iridotomy was temporarily beneficial, but it had to be repeated several times.
The renal growth hormone/insulin-like growth factor I axis. Collecting duct is a major site of insulin-like growth factor-I (IGF-I) synthesis within kidney. Production of IGF-I at this site is stimulated by growth hormone (GH). IGF-I produced in collecting duct is likely to act on glomerulus and proximal tubule via IGF-I receptors present at these locations. Renal IGF-I may be causative of the glomerular and proximal tubular hypertrophy that occurs in hypersomatotropic states, of compensatory renal hypertrophy, and of renal regeneration following acute ischemic injury.
Evaluation of penile dorsal arteries and deep arteries in arteriogenic impotence. The dorsal and deep arteries are the 2 main blood supplies to the penis. High resolution ultrasonography was used to evaluate the role of these 2 sets of arteries in erection. A total of 44 impotent patients entered this study. We used duplex ultrasonography (Diasonic DRF/400) to assess the role of the dorsal and deep arteries in arteriogenic and nonarteriogenic impotent patients. Vascular velocity, as well as the change in diameter, was recorded before and after an intracavernous injection of 60 mg. papaverine. In the arteriogenic impotence group (28 patients, 63.6%), the velocity increments were 37.1 +/- 23.6 (right side) and 35.4 +/- 17.5 (left side) cm. per second in the dorsal arteries, and 8.3 +/- 5.9 (right side) and 12.6 +/- 5.6 (left side) cm. per second in the deep arteries. In the nonarteriogenic group (16 patients, 36.4%) the velocity increments were 46.5 +/- 25.2 and 41.1 +/- 22.4, respectively, in the dorsal arteries, and 37.3 +/- 16.5 and 37.5 +/- 15.8, respectively, in the deep arteries. Comparison of the velocity increments between the arteriogenic and nonarteriogenic groups revealed no difference in the dorsal arteries (p greater than 0.1) but a significant difference was noted in the deep arteries (p less than 0.01). Similar findings were also encountered when the velocities and diameter increments were compared. This study indicates that the deep arteries have an important role in erectile response, while the dorsal arteries are less important.