shukoor65/lab-rag-model huggingface dataset:
Molteno implantation for glaucoma in young patients. Seventy patients younger than 21 years of age underwent Molteno implantation for nonneovascular glaucoma. Fifty-three (76%) patients had failed angle and/or conventional filtering surgery. Final intraocular pressure less than 22 mmHg (but over 5 mmHg) was achieved in 40 (62%) of the 65 patients with at least 6-month follow-up (range, 6 to 59 months; mean +/- standard deviation, 22.7 +/- 14.1 months); however, only 22 (34%) were controlled after the initial Molteno implantation procedure, and 54 (83%) patients underwent further glaucoma and/or nonglaucoma surgical procedures. The visual acuities remained within one line of their preoperative levels or improved in 25 (68%) of the 37 patients on whom Snellen acuities were available. The most frequent complications included: tube-cornea touch (20%, transient in 3%), corneal edema (17%), retinal detachment (16%), tube block (10%), cataract (9%), chronic hypotony or phthisis (9%), pupillary or cyclitic membrane (9%), hyphema (7%), flat anterior chamber (6%), and large postoperative choroidal effusion (6%). Despite the high rates of subsequent surgical interventions and complications, Molteno implantation has been a useful approach for achieving intraocular pressure reduction in young patients with glucoma.
Dietary protein restriction stress and adrenocortical function: evidence for transient and long-term induction of enhanced cellular function. Previous work has demonstrated that 4-week protein restriction of the domestic fowl (Gallus gallus domesticus) increases both adrenocortical cell sensitivity to ACTH and corticosteroidogenic capacity. In the present study we examined the transience (study 1) and the persistence (study 2) of this effect of protein restriction. In study 1, two strains of domestic fowl were used: a slower-growing White Leghorn strain and a faster-growing Cobb broiler strain. Cockerels (2 weeks old) were fed isocaloric diets containing either low (L; 5% or 8%) or control (C; 20%) levels of soy protein for 2 weeks, and then were either switched to the alternate diet (C-L, L-C) or maintained on the initial diet (C-C, L-L) for an additional 2 weeks. Cockerels were killed at 6 weeks of age. In study 2, White Leghorn cockerels (2 weeks old) were fed either diet for 4 weeks and then switched to or maintained on the control diet for an additional 4 weeks (i.e. C vs. restriction followed by repletion). In this study cockerels were killed at 10 weeks of age. In both studies highly enriched populations of adrenocortical cells were isolated from cockerel adrenal glands, and their steroidogenic properties (basal and maximally induced corticosterone and cAMP production; steroidogenic agent ED50 values) were evaluated in 2-h suspension incubations. In study 1, regardless of strain, the greater the length of the restriction period, the greater the magnitude of maximal cellular corticosterone production induced by ACTH; the average value for 4-week restriction (L-L) was 39.5% greater than that for 2-week restriction (L-C, C-L) and 117.5% greater than that for control (C-C). In addition, the value for restriction from 4-6 weeks of age (C-L) was 34% greater than that for restriction from 2-4 weeks of age (L-C), suggesting that the enhancement of maximal ACTH-induced corticosterone production after a 2-week restriction interval might be transient. Although there were no strain differences in the effect of protein restriction on maximal ACTH-induced corticosterone production, there were strain differences in its effect on cellular sensitivity to ACTH, as indicated by the ACTH ED50 values (the lower the ED50 value, the greater tha cellular sensitivity). With the White Leghorn strain, the greater the duration of protein restriction, the greater the adrenocortical cell sensitivity to ACTH; the sensitivity of L-L cells was 3.0 times the sensitivities of L-C and C-L cells and 4.1 times the sensitivity of C-C cells.(ABSTRACT TRUNCATED AT 400 WORDS).
Localization of receptors for luteinizing hormone-releasing hormone in pancreatic and mammary cancer cells. Previous work showed that hamster and human pancreatic tumors but not normal pancreata exhibit low-affinity cell-membrane receptors for luteinizing hormone-releasing hormone (LHRH). Although the regression of experimental pancreatic cancers induced by treatment with LHRH agonists or antagonists could be explained in part by the creation of sex-steroid deficiency, direct effects mediated by LHRH receptors might also play a role. Here, we demonstrate that pancreatic tumor cells do exhibit high-affinity binding sites for LHRH, but only in their nuclei; low-affinity sites are associated with the cell membranes. These binding sites appear to be LHRH receptors since electron microscopic immunohistochemical studies show that an antibody to the LHRH receptor reacted with sites in the nucleus of pancreatic tumor cells. Immunoreactive sites in the nucleus also were found in a restricted set of normal hamster pituitary cells thought to be luteinizing hormone-secreting cells and in MXT mouse mammary tumor cells. Such nuclear receptors may be involved in the transmission of the direct action of LHRH analogues on the tumor cells, resulting in the enhancement of programmed cell death.
Pneumonitis associated with coinfection by human herpesvirus 6 and Legionella in an immunocompetent adult. The authors report a case of pneumonitis in a young healthy man caused by coinfection with human herpesvirus 6 (HHV-6) and Legionella pneumophila. The patient's course was complicated by severe respiratory, renal, hepatic, and central nervous system dysfunctions, which were believed to be primarily the results of his Legionella infection. Aggressive antibiotic treatment produced no response, and Legionella remained isolatable from lung tissue throughout several weeks of antimicrobial therapy. Human herpesvirus 6 was isolated from a sample of peripheral blood during the acute stage of the patient's illness, and numerous HHV-6--infected macrophages and lymphocytes were detected by immunohistochemical staining of biopsy-derived lung tissue. Paradoxically treatment of the patient with high-dose corticosteroids resulted in dramatic improvement of his condition, including clearance of the Legionella infection. The demonstration that corticosteroids efficiently inhibit HHV-6 replication in vitro suggests that the virus may have contributed to the patient's pneumonitis by enhancing tissue inflammation, by compromising the function of pulmonary macrophages, and, perhaps, by destroying the patient's CD4+ T lymphocytes. Human herpesvirus 6 may be able to function as a synergistic cofactor in lung infections by Legionella and other pathogens.
Determination of cerebrospinal fluid shunt obstruction with magnetic resonance phase imaging. The cerebrospinal fluid (CSF) flow rates in 12 patients with symptoms suggestive of CSF shunt obstruction were measured with magnetic resonance (MR) phase imaging. The shunts were imaged over the skull, just distal to any reservoir, using a curved surface coil. Images perpendicular to the direction of flow were made on a 1.5-tesla clinical unit with a flow-sensitive pulse sequence. The patients' ages ranged from 2 months to 28 years. All patients had ancillary investigations to determine the functional status of the shunt. No flow was detected in seven patients with blocked shunts. Flow rates between 3 and 40 cc/hr were found in three patients with functioning shunts. Two patients, one with a blocked shunt and one with a functioning shunt, could not be imaged due to motion artifact. Magnetic resonance phase imaging is a promising technique in the determination of CSF shunt obstruction.
An analysis of the aetiology of early childhood deafness. It is generally believed that one in every thousand children is profoundly deaf. An understanding of the aetiology of early childhood deafness and timely detection is crucial in rehabilitation of these children. This study analyses the aetiology of early childhood deafness and shows that deafness is more often acquired than inherited. Non-syndromic deafness, especially occurring on its own, usually produces profoundly deaf children and thus there is the need for genetic studies--in the child, laterally, and longitudinally into generations. Meningitis appears to be the commonest cause of acquired deafness, especially if due to pneumococcus. Only 40 of the 80 cases presented before the age of 2 years. It was therefore interesting to note what factors invoked awareness of deafness to facilitate early presentation.
The effect of cryopreservation on the development of S- and G2-phase mouse embryos. The survival rate and development of four-cell-stage mouse embryos frozen and thawed in S phase versus G2 phase was compared. Significantly more G2-phase than S-phase embryos survived freezing and thawing. In both groups, disruption of the zona pellucida, fusion of blastomeres, and dispersion of chromosomes were occasionally observed after thawing. Cryopreservation resulted in a longer delay in cleavage from the four- to the eight-cell stage of S (about 5 hr)- and G2-phase embryos (about 3 hr) compared to unfrozen controls. The number of frozen embryos which developed to the blastocyst stage was reduced compared to controls, and in the case of S-phase embryos, formation of the blastocyst cavity was also delayed. However, the average number of cells in the experimental and control embryos was similar. No increased incidence of chromosome abnormalities was seen. Our results suggest that freezing embryos in G2 is superior to freezing in S phase.
The cosmetic effects of submucous resection. A prospective assessment of the complications of submucous resection is presented. Preoperative photographs were taken and a post-operative assessment was carried out at a minimum time of 2 years by questionnaire and photographs. No examples of significant cosmetic changes were found.
Laser midline glossectomy as a treatment for obstructive sleep apnea. Multiple site specific procedures have been proposed to treat obstructive sleep apnea syndrome (OSAS). Midline glossectomy (MLG) is a procedure that directly enlarges the hypopharyngeal airspace using the carbon dioxide laser. The initial experience of 12 patients is presented. Midline glossectomy as the sole procedure was performed on 11 patients who had failed uvulopalatopharyngoplasty (UPPP) and who were felt to have significant hypopharyngeal collapse on physical examination and Muller's maneuver. One patient with primary hypopharyngeal narrowing underwent MLG. Five (42%) were considered responders with Respiratory Disturbance Index (RDI) decreasing from 60.6 per hour to 14.5 per hour. In seven nonresponders, there was no significant change in the RDI (62.6 events per hour to 48.4 events per hour). Cephalometric analysis showed that responders tended to be more retrognathic (sella-nasion-supramentale (S-N-B = 74.4 degrees)) than nonresponders (S-N-B = 79.3 degrees). Responders were significantly less obese (body mass index (BMI = 30.6)) than nonresponders (BMI = 37.9). There were five minor complications including minor bleeding (n = 3), prolonged odynophagia (n = 1), and minor change in taste (n = 1). There were no major complications, and no persistent difficulties with speech or swallowing. These results demonstrate that direct surgical modification of the tongue base and associated structures can significantly impact obstructive apnea. Midline glossectomy or similar procedures may be useful in a subset of patients with OSAS.
Electroencephalographic correlations of extracranial and epidural electrodes in temporal lobe epilepsy. Thirty patients with medically intractable complex partial seizures of temporal lobe origin, but no structural abnormalities on neuroradiologic investigations, had both extracranial (scalp) and epidural EEG recordings. Fifteen patients (50%) had localized, unilateral, ictal, scalp EEGs, but one of these had bilateral independent temporal seizure onset according to epidural recordings. Of the 15 patients in whom scalp EEGs were non-localizing, 12 had well-localized epidural ictal EEGs, and 3 had multifocal or bilateral independent temporal ictal recordings. Epidural recordings provide information for determination of site of onset of temporal lobe seizures in selected patients.
Acute hemorrhagic necrosis of tumors induced by interleukin-1 alpha: effects independent of tumor necrosis factor. Tumor necrosis factor (TNF), a protein synthesized in response to the endotoxin bacterial lipopolysaccharide (LPS), is the classical mediator of acute hemorrhagic necrosis of tumors. We have demonstrated that interleukin-1 alpha (IL-1 alpha), with a spectrum of activities very similar to those of TNF, also causes acute hemorrhagic necrosis of tumors. Both TNF and IL-1 induce a cascade of events including the synthesis or release of each other. The present studies were thus undertaken to determine whether the hemorrhagic necrosis induced in tumors by IL-1 alpha is due to TNF. Kinetic parameters of IL-1 alpha-induced hemorrhage were similar to those observed with recombinant murine TNF-alpha (TNF-alpha) or LPS in RIF-1 fibrosarcomas in C3H/HeN (endotoxin-sensitive) mice. However, the amount of TNF found in the sera or tumors of animals treated with LPS was more than 20-fold higher than in mice treated with IL-1 alpha, and LPS induced similar degrees of hemorrhagic necrosis, which was measured by determining the packed volume of red blood cells by 59Fe labeling. A low but significantly hemorrhagic dose of IL-1 alpha induced no detectable TNF in tumors. Pretreatment with 250 micrograms of neutralizing antibody to TNF had no effect on IL-1 alpha-induced hemorrhage, whereas TNF-alpha- and LPS-induced hemorrhagic effects were significantly reduced. These results demonstrate an important antitumor activity of IL-1 alpha that appears to be independent of TNF.
Detection of pancreatic fluid and urine leakage after pancreas transplantation: value of CT and cystography. Leakage from the urinary bladder or duodenal stump after pancreas transplantation with urinary bladder drainage of the graft is difficult to diagnose clinically. We retrospectively reviewed our experience with fluoroscopic cystography and CT to determine their relative merit in the diagnosis of pancreatic fluid and urine leakage as documented by surgical exploration in pancreas transplant recipients. Thirteen leaks were diagnosed by fluoroscopic cystography or by CT in 11 patients after pancreas transplantation with urinary bladder drainage of pancreatic fluid. Conventional retrograde fluoroscopic cystography showed 11 leaks; CT with retrograde bladder opacification showed three leaks. Of the five CT studies that did not show a leak and that also were done within 7 days of a cystogram with abnormal findings, failure to use retrograde bladder opacification accounted for the majority (three cases) of missed diagnoses. Focal or free peritoneal abdominal fluid was seen in all CT examinations, with extravasation of contrast material seen into both walled-off collections and free ascites. Our experience suggests that retrograde bladder and duodenal stump opacification should be a routine part of the CT evaluation performed to detect leakage from the urinary bladder or duodenal stump after pancreas transplantation.
Breast cancer in men: aspects of familial aggregation. Familial aggregation of breast cancer in males was investigated in a population-based case-control study. Cases were ascertained from 10 Surveillance, Epidemiology, and End Results Program registries in the United States between 1983 and 1986. Controls were identified by random-digit dialing and from lists of Medicare recipients. The relative odds of developing breast cancer were similar in men with affected paternal and maternal relatives and in men with affected mothers and sisters. The risk increased with the number of affected relatives. The relative odds of developing breast cancer were greater in men with first-degree relatives who developed their mammary neoplasm before the age of 45 than in men with older first-degree affected relatives; the enhancement of risk in men with an affected sister was greater in those under age 60 than in older men. These results are similar to those observed by others in studies of breast cancer in women.
Mitral valve repair: a valuable procedure with good long term results even when performed infrequently. OBJECTIVE--To assess the results of mitral valve repair in a series with a low frequency of repair despite a policy to conserve the valve whenever possible. DESIGN--Retrospective review of case notes with clinical and echocardiographic examination of survivors. SETTING--Cardiac surgery unit in a university teaching hospital. PATIENTS--62 consecutive patients undergoing mitral valve repair by one surgeon between 1979 and 1989. INTERVENTIONS--Mitral valve repair according to the criteria and techniques of Carpentier. MAIN OUTCOME MEASURES--Frequency of repair, operative mortality, actuarial survival, freedom from reoperation and thromboembolism, clinical state, and echocardiographic state. RESULTS--The 62 patients, median age 58 years (interquartile range 51 to 64 years), represent 14% (70% confidence interval 12% to 15%) of the 454 mitral valve operations performed in the study period. Operative mortality was 8% (70% CI 5% to 13%). Actuarial survival was 62% (70% CI 43% to 81%) at nine years. At nine years actuarial freedom from reoperation was 91% (70% CI 79% to 102%) and freedom from thromboembolism 91% (70% CI 80% to 102%). At a median follow up of 33 months (interquartile range 21 to 74 months), 38 of 46 survivors had improved functional state. Of 21 patients who underwent echocardiography one had severe mitral regurgitation and one mitral stenosis. CONCLUSION--Although compared with other reports of mitral valve repair the prevalence of repair was low in this series the results are comparable and justify a positive approach to repair in all patients undergoing mitral valve surgery even if this can only be achieved in a small proportion of patients.
A combination trial of human lymphoblastoid interferon and bestrabucil (KM2210) for adult T-cell leukemia-lymphoma. Both human lymphoblastoid interferon (HLBI) and bestrabucil, the conjugate of chlorambucil and beta-estradiol, have antitumor activity against adult T-cell leukemia-lymphoma (ATLL). Because an in vitro study showed that these two agents combined had a synergistic antiproliferative effect on MOLT-4 and WI-38VA13 cell lines, the authors evaluated the clinical efficacy of this combination in a pilot study with a poor-risk group of ATLL patients. The patients were treated daily with 6 x 10(6) IU of HLBI subcutaneously and 100 mg of bestrabucil orally. In patients with lymphoma-type ATLL or hypercalcemia, prednisolone also was given daily. Of 12 patients suitable for evaluation, nine had partial responses, one had a minor response, and two had no response. All five patients with skin infiltration and both patients with hypercalcemia responded. A history of prior chemotherapy did not affect the response rate. The time to clinical response was 3 to 16 days (median, 11 days) after initiation of treatment. The response duration was 4 to 108+ weeks (median, 9 weeks), but all patients except one relapsed, even during continuing treatment. No serious side effects were observed. Although the response rate with this combination treatment was high, the response duration was short, and other treatments would have to be added to achieve control of this aggressive disease.
Surgical treatment for a case of postoperative Pseudallescheria boydii endophthalmitis. Pseudallescheria boydii (P. boydii) is an uncommon ocular pathogen which previously has been identified in only 10 of 905 fungal isolates identified by the Sid Richardson Microbiology Laboratory at the Cullen Eye Institute of Baylor College of Medicine. Furthermore, only one case of postoperative P. boydii endophthalmitis and four cases of endogenous P. boydii endophthalmitis have been reported. Three of the four patients with endogenous endophthalmitis died within 4 weeks of diagnosis. We describe a second case of postoperative endophthalmitis due to this fungus. The infection was successfully eradicated following vitrectomy, corneoscleral resection, and patch graft, in addition to intraocular, topical, and oral antifungal medication. Although in vitro sensitivities are variable, P. boydii is known to be relatively resistant to amphotericin B. This points to the importance of proper cultures and sensitivities when treating cases of suspected fungal endophthalmitis. Unfortunately, the patient's eye became phthisical 6 months following the initial intervention.
Antibiotic treatment of tuboovarian abscess: comparison of broad-spectrum beta-lactam agents versus clindamycin-containing regimens. One hundred nineteen patients with tuboovarian abscess were evaluated for response to antibiotics. Results were stratified into three groups by antimicrobial regimen. Group 1 consisted of 37 patients treated with a single-agent broad-spectrum intravenous antibiotic and oral doxycycline. Initial clinical response (defined as decreased pain, diminished white blood cell count, or defervescence) in group 1 was 31/37 (84%). Group 2 consisted of 64 patients treated with clindamycin in combination with an aminoglycoside with or without a penicillin. There was an initial clinical response in 45 of 64 (70%). Group 3 consisted of 18 patients from group 1 who were changed to a clindamycin-containing regimen after 2 to 3 days of initial treatment with a single-agent broad-spectrum antibiotic. The decision to switch antibiotics was not based on treatment failure but occurred when delayed ultrasonography confirmed the diagnosis of tuboovarian abscess. The switch reflected physician preference for clindamycin-containing regimens in the treatment of tuboovarian abscesses. The response rate in this subset of patients was 14 of 18 (78%). Overall initial clinical response rate was 90 of 119 (75%). There were no statistically significant demographic or clinical differences among the three groups. There was no statistical difference in the rate of early and late antibiotic failure rates among the groups. Our study demonstrates that extended-spectrum antibiotic coverage, including single-agent broad-spectrum antibiotics such as cefoxitin, in conjunction with doxycycline has efficacy that is equivalent to that of clindamycin-containing regimens. An overall medical treatment success rate of 75% suggests that conservative treatment of tuboovarian abscesses is warranted.
Hemodynamic response with passive neck flexion in brain death. Twelve brain-dead patients admitted to the Department of Traumatology, Osaka University Hospital, from July 1988 to August 1989 were studied. A hemodynamic response elicited by passive neck flexion was observed in 10 of the 12 patients. After passive neck flexion, blood pressure began to rise, and the heart rate increased slightly. Blood pressure peaked about 2 minutes after the initiation of neck flexion and then decreased gradually to the baseline level within a few minutes. These responses were suppressed completely by administration of the ganglion blocker trimethaphan camsilate, which suggests that the efferent pathway of the response is mediated by the sympathetic nervous system.
Extracapsular cataract extraction with posterior chamber lens implantation in Fuch's heterochromic cyclitis. Twenty-two patients with Fuch's heterochromic cyclitis had a posterior chamber intraocular lens implanted after extracapsular cataract extraction. After a mean follow-up period of 2.5 years (range, 6 to 70 months) half the patients had a visual acuity of 1.0 or more. The results compare favourably with those in the general population.