shukoor65/lab-rag-model huggingface dataset:
Digitally-directed transrectal biopsy using Biopty gun versus transrectal needle aspiration: comparison of diagnostic yield and comfort. A technique for digitally-directed core biopsy using the Biopty device and prospective comparison of accuracy and comfort, using this technique simultaneously with transrectal needle aspiration, are presented. To better estimate the true prevalence of carcinoma in the study population, a repeat combined procedure was performed on all subjects who did not have carcinoma confirmed on the initial core biopsies. All procedures were done by one investigator and all pathology reviewed by one senior pathologist. A total of 180 combined procedures were performed on 100 consecutive patients with palpably abnormal prostates; 30 carcinomas were detected. Digitally-directed Biopty biopsy yielded a sensitivity rate of 87 percent compared with 57 percent for needle aspiration (p less than 0.05). Using a numerical comfort scale, the Biopty device was also rated less painful than needle aspiration (p = 0.0001). The morbidity of the combined procedure was minimal, with a minor complication rate of 2.2 percent. No infections occurred.
Epidemiologic correlates of sporadic amyotrophic lateral sclerosis. We evaluated 74 selected patients with amyotrophic lateral sclerosis (ALS) and 201 matched controls for risk factors for ALS by a case-control design and a sequential questionnaire/interview technique to quantitate biographic data. We analyzed occupational and recreational data only for 47 male patients and 47 corresponding patient controls; data for women were insufficient. We used nonparametric analyses to evaluate five primary comparisons of ALS patients with controls: (1) more hard physical labor, p not significant (NS); (2) greater frequency of neurodegenerative disease in family members, p NS; (3) greater exposure to lead, p less than 0.05; (4) more years lived in a rural community, p NS; and (5) more trauma or major surgery, p NS. Men with ALS had worked more frequently at blue-collar jobs (although not a statistically significant difference, p = 0.10) and at welding or soldering (p less than 0.01). These results suggest that there may be an association between ALS in men and exposure to lead vapor. The limited nature of the association favors a multifactorial etiologic mechanism of ALS.
Altered corticospinal projections to lower limb motoneurons in subjects with cerebral palsy. The projections of cortical neurons activated by transcranial magnetic stimulation to the motoneurons of lower limb muscles were examined in 22 normal subjects and 14 subjects with cerebral palsy (CP). In normal subjects, magnetic stimulation produced strong facilitation of tibialis anterior (TA) motoneurons, but little or no facilitation of soleus (SOL) motoneurons. This differential facilitation of TA and SOL motoneurons was observed at all stimulus sites on the scalp and all stimulus intensities at which responses could be elicited. In subjects with CP, magnetic stimulation produced almost equal facilitation of TA and SOL motoneurons. This could not be explained by differences in the excitability of the respective motoneuron pools. It is postulated that the projections from the motor cortex to spinal motoneurons are altered in CP. These abnormal projections may contribute to the impairment of voluntary movements experienced by these subjects.
HLA-DR antigen expression on peripheral blood monocytes correlates with surgical infection. Monocyte human leukocyte antigen-DR (HLA-DR) expression has correlated closely with clinical outcome in severely injured patients at high risk for infection. Monocytes from 77 asymptomatic volunteers expressed HLA-DR antigen with minimal variability in respect to age, gender, race, time of day or year, or serum alcohol level. Patients who developed infection after elective laparotomy had a significantly lower mean percentage of monocytes expressing HLA-DR antigen and a lower mean fluorescent intensity than uninfected patients (p less than 0.05). Severely infected nonsurgical patients had significantly lower values than normal volunteers (p less than 0.01), and the mean fluorescent intensity of those who died from infection was significantly lower than that of those who survived (p less than 0.05). Patients on immunosuppressive regimens after renal transplantation had levels of HLA-DR expression similar to those of the volunteers. Monocyte HLA-DR expression was found to be a reliable marker of clinical infection and showed remarkable reproducibility within the normal uninfected study population.
The natural history of multiple endocrine neoplasia type 1. Highly uncommon or highly unrecognized? Among 2000 descendants of an English immigrant to Tasmania, Australia, the diagnosis of multiple endocrine neoplasia type 1 was found to be very highly probable or highly probable in 130 and moderately probable in 22. Another 242 children and siblings were 50% likely to have inherited this dominant gene. In all age groups, especially the elderly, the majority of affected members had symptoms of only one endocrine disorder or were asymptomatic. In teenagers, the most common presentation was pituitary lesions and the second most common presentation was insulinomas. Frequently, pituitary lesions or insulinomas developed before any parathyroid lesions could be detected. Elevation of gastrin levels, usually associated with hypercalcemia, was rarely seen in patients younger than 25 years. The classic presentation with symptoms of multiple endocrinopathy may represent only a small fraction of these patients in the community.
Identification of perilymph proteins by two-dimensional gel electrophoresis. Perilymph has a total protein component that is quantitatively distinct from serum and cerebrospinal fluid (CSF). The goal of this research was to determine if perilymph contains any qualitatively unique protein constituents that will distinguish it from serum or CSF. To test this hypothesis, matched sets of perilymph, serum, and CSF were obtained from 18 guinea pigs and seven human subjects. The purity of each sample was assured by measurement of the protein concentration of each sample and comparison of this parameter to known normal values for perilymph, serum, and CSF. Each sample was then subjected to two-dimensional gel electrophoresis, separating proteins by isoelectric point in the horizontal dimension and by relative molecular weight in the vertical dimension. All gels were processed under precisely identical physical conditions by use of a diamine silver stain. A small number of perilymph proteins not found in plasma were identified in both the guinea pig and the human specimens. The finding of unique perilymph proteins may permit the development of a sensitive marker that will aid in the diagnosis of perilymph fistula.
Association of supraglottic and gingival idiopathic plasmacytosis. Three cases of gingival plasmacytosis in which laryngeal symptoms eventually developed are reported. Two of the three patients underwent endoscopic biopsy of supraglottic lesions, which proved to be similar to those in the oral cavity. The third patient had supraglottic erythema only and was not subjected to biopsy. Known etiologic factors associated with plasma cell gingivitis were excluded. Treatment with oral and topical steroids resulted in good control of the lesions.
Prognostic significance of acute epilepsia partialis continua. We present 3 patients in whom epilepsia partialis continua was the presenting sign of an acute, rapidly evolving and catastrophic neurologic illness. Initial seizures were partial simple (i.e., eye deviation in one, finger twitching in one) which progressed to multifocal partial seizures. The course of the epilepsia partialis continua was 36-41 days. Prognosis was uniformly poor (i.e., death in 2, vegetative state in 1); therefore, epilepsia partialis continua in the context of an acute neurologic illness may herald a grim outcome.
Effects of electrophysiologic testing of the automatic implantable cardioverter-defibrillator on left ventricular systolic function and diastolic filling. We investigated the effects of electrophysiologic testing of the automatic implantable cardioverter-defibrillator (AICD) on left ventricular systolic function and diastolic filling in 12 patients. Ventricular tachycardia or ventricular fibrillation was induced by programmed electrical stimulation and alternating-current, respectively. Patients were studied before and immediately after, 10 minutes after, and 1 hour after defibrillation by the AICD using M-mode, two-dimensional, and pulsed Doppler echocardiography. Immediately after defibrillation, increases were found in the peak early filling velocity (70 +/- 10 cm/sec to 84 +/- 24 cm/sec, p less than 0.01), peak early-to-atrial filling velocity ratio (1.05 +/- 0.21 to 1.29 +/- 0.26, p less than 0.005), and maximum rate of diastolic chamber enlargement (82 +/- 26 mm/sec to 102 +/- 44 mm/sec, p less than 0.05). These changes were not evident at 10 minutes and 1 hour. Cardiac output and ejection fraction were unchanged after defibrillation. Heart rate and diastolic filling time were unchanged. We conclude that electrophysiologic testing of the AICD does not impair left ventricular function in the immediate to 1-hour period after defibrillation. Left ventricular systolic function is unchanged and diastolic filling is enhanced.
Association between plasma viscosity and blood pressure. Results from the MONICA-project Augsburg. The relationship between determinants of blood viscosity and blood pressure (BP) variables was studied in a large sample of a population aged 25 to 64 years. Plasma viscosity, hemoglobin, and total serum protein were examined. Systolic and diastolic BP and the prevalence of hypertension showed a crude positive association with plasma viscosity levels in both sexes. Age, body mass index, and total serum protein appeared to have a confounding effect on this relationship, whereas hemoglobin, smoking behavior, and alcohol consumption did not. A crude positive association was also found between total serum protein levels and the prevalence of hypertension in men and women; however, since total serum protein was treated as a covariable, no further analyses were carried out. In contrast to findings reported in the literature, hemoglobin levels were not correlated with BP variables in either sex. After adjusting for all confounders, a significant main effect of plasma viscosity still was found. However, the magnitude of the effect was not as large as for body mass index, a well-established risk variable for hypertension. These results indicate that BP is positively associated with plasma viscosity. Whether increased plasma viscosity in hypertension constitutes a primary or a secondary phenomenon remains to be answered. Since plasma viscosity is significantly associated with hypertension but any BP variable, increased levels of plasma proteins (particularly fibrinogen as the main determinant of plasma viscosity) may represent the cause for elevated plasma viscosity. This might contribute to persistently increased resistance to blood flow on the microcirculatory level in arterial hypertension.
Fibroblast stimulation in schistosomiasis. XI. Purification to apparent homogeneity of fibroblast-stimulating factor-1, an acidic heparin-binding growth factor produced by schistosomal egg granulomas. Liver fibrosis is the most serious complication of infection with Schistosoma mansoni and Schistosoma japonicum and is responsible for severe morbidity and mortality in hundreds of thousands of patients in many Third World nations. The pathogenesis of this condition remains to be elucidated. We proposed that certain cytokines produced by cells that comprise the chronic granulomas that surround the helminth eggs within the liver initiate hepatic fibrogenesis. We now report our successful purification to apparent homogeneity of the egg granuloma-derived fibroblast mitogen. The high affinity of this factor for heparin (elutes from heparin-Sepharose with 1.5 M NaCl) facilitates its purification by a two-step procedure, and identifies the cytokine as a heparin-binding growth factor (HBGF). Furthermore, because it has an isoelectric point approximately equal to 6.2, it has one of the characteristics of a class 1 (acidic) HBGF. We immunized rabbits with the purified factor and observed that the resulting antibodies (IgG) detected the factor but not acidic fibroblast growth factor (the prototypic class 1 HBGF) either by dot-blot ELISA or neutralization of biologic activity. The granuloma product and fibroblast growth factor also differ in target-cell specificity and amino acid composition. On the basis of these distinctions, we have designated the granuloma-derived mitogen fibroblast-stimulating factor-1. With the availability of purified fibroblast-stimulating factor-1 and the future analysis of its amino acid sequence, its structural relationship to other mesenchymal growth factors can be determined.
Mixed venous oxygen saturation as a guide to tissue oxygenation and prognosis in patients with acute myocardial infarction. The relation of mixed venous oxygen saturation and the cardiac index to tissue oxygenation and prognosis was investigated in 119 patients with acute myocardial infarction. There was a positive correlation between mixed venous oxygen saturation and the cardiac index in 97 survivors and 22 nonsurvivors, but a significantly lower mixed venous oxygen saturation level at the same level of cardiac index was observed in nonsurvivors compared with survivors. Results of multivariate analysis with mixed venous oxygen saturation and the cardiac index indicated that only mixed venous oxygen saturation was significantly related to survival and to hyperlactacidemia. Oxygen delivery to tissues declined significantly in nonsurvivors because of a lower cardiac index and a lower hemoglobin concentration in these patients than in survivors. However, at the same level of oxygen delivery to tissues, nonsurvivors had a significantly higher rate of oxygen consumption leading to a correspondingly greater decrease in mixed venous oxygen saturation, suggesting that a greater increase in oxygen demand was also observed in nonsurvivors than in survivors. Thus mixed venous oxygen saturation after acute myocardial infarction is a better predictor of hyperlactacidemia and survival than the cardiac index, and this may be associated with an increased oxygen demand and an impaired oxygen transport system in seriously ill patients.
Effects of sympathectomy in a model of causalgiform pain produced by partial sciatic nerve injury in rats. In a previous report we presented a novel behavioral model of neuropathic pain disorders, produced in rat by a unilateral ligation of about half of the sciatic nerve. The model is characterized by rapid onset of behaviors suggesting spontaneous pain and disordered responses to non-noxious and noxious stimuli. These include reduced withdrawal thresholds to repetitive touch in the partially deafferented skin ('touched-evoked hyperesthesia'), touch-evoked allodynia, reduced withdrawal thresholds to noxious thermal stimuli and exaggerated responses to noxious heat and mechanical stimuli ('thermal hyperalgesia'). Some of these disorders are seen at mirror image sites on the hind limb opposite the lesion. These disorder start within hours after partial nerve injury, last many months and are very similar to causalgia in humans following partial nerve injury. Since sympathetic efferent activity is known to aggravate causalgia in humans and sympathectomy is known to relieve it, we studied the effect of changing sympathetic outflow in the rat model. Reversible sympathectomy was carried out using guanethidine injected intraperitoneally in 3 experiments, each at a different time in relation to the partial nerve injury. We found that: (1) sympathectomy performed several months postoperatively alleviated the sensory disorders bilaterally; (2) sympathectomy prior to nerve injury partially prevented the appearance of thermal hyperalgesia but did not affect hyperesthesia to repetitive touch; and (3) sympathectomy at the time of nerve injury aggravated the sensory disorders during the first few days. As maintenance and production of the sensory disorders in this animal model depended on sympathetic nervous outflow, we conclude that the rats were suffering from a syndrome analogous to sympathetically maintained causalgia in man.
Gastric antral vascular ectasia associated with gastric carcinoma. Gastric antral vascular ectasia (GAVE), or watermelon stomach, is an uncommon cause of chronic gastrointestinal blood loss and iron deficiency anemia. Although GAVE has not previously been reported in association with gastric cancer, it is often associated with atrophic gastritis and pernicious anemia, which are known risk factors for gastric malignancy. We report a 72-yr-old woman with pernicious anemia who was found to have GAVE associated with adenosquamous carcinoma of the gastric cardia and adenocarcinoma in situ of the pylorus. In view of recent reports of the use of endoscopic modalities rather than surgical resection to treat GAVE, our case alerts endoscopists to the possibility of coexisting carcinoma.
Life-threatening cervico-mediastinal haematoma after carotid sinus massage. Retropharyngeal and cervico-mediastinal haematomas are rare but potentially fatal entities. The potential for airway compression necessitates rapid assessment and treatment. A cervico-mediastinal haematoma following carotid sinus massage which required cervical drainage is presented. This is a life-threatening event demanding a high index of suspicion. A review of the literature and indications for treatment are discussed.
Ultrasound diagnosis of an obstructive cardiac rhabdomyoma with severe hydrops and hypoplastic lungs. A case report. Cardiac rhabdomyomas of the fetus and neonate are benign cardiac muscle hamartomas with an incidence of 0.027% in pediatric autopsies. This is the third reported case of prenatally diagnosed cardiac rhabdomyoma, the second with severe hydrops and the only one associated with aortic valve hypoplasia and hypoplastic lungs.
Nausea and vomiting with use of a patient-controlled analgesia system. The incidence of nausea and vomiting following patient controlled analgesia and intramuscular morphine injections on demand was compared in a double-blind randomised study of 32 healthy patients undergoing elective cholecystectomy. There were no significant differences between the two groups in mean 24 hour postoperative morphine consumption, subjective experience of pain, nausea and sedation assessed by visual linear analogue scoring, and the postoperative requirements for antiemetic therapy.
Potential availability of cadaver organs for transplantation OBJECTIVE--To determine the potential number of cadaver kidney donors by applying defined donor criteria to people dying in hospital. DESIGN--Prospective study of all deaths occurring in 21 hospitals from 1 September 1988 to 31 August 1989. Questionnaires were administered to medical and nursing staff and families of potential donors aged 1-69. SETTING--Acute care hospitals in Gwent, South Glamorgan, Mid Glamorgan, West Glamorgan, Pembrokeshire, and East Dyfed health authorities, serving a population of 2.2 million. MAIN OUTCOME MEASURES--Cause of death, age, ventilation at time of death, diagnosis of brain death, and consideration of consent. RESULTS--Adequate data were available for 9840 of 10,095 hospital deaths (97.5% coverage). 188 patients aged 0-69 were identified as potential organ donors (widest definition), and of these 108 died without being ventilated at the time of death. Tests of brain stem death were formally completed in 57 cases, and organ donation was considered by the families of 47 of these potential donors. 26 patients became organ donors. Patients aged 50-69 with stroke were less likely to be ventilated than those aged less than or equal to 49 (21/96 v 24/34). Families of potential donors aged 20-39 were least likely to give permission. CONCLUSIONS--The supply of donor organs (specifically kidneys) could be increased by altering the management of patients aged 50-69 dying of severe cerebrovascular disease in general medical wards, in particular by increasing the proportion ventilated. The ethics of elective ventilation for the purposes of organ donation require discussion.
Recurrent condylomata acuminata treated with recombinant interferon alfa-2a. A multicenter double-blind placebo-controlled clinical trial. Condylomata International Collaborative Study Group. Systemic interferon has been advocated as an effective therapy for recurrent genital warts. A double-blind, placebo-controlled, multicenter international trial involving 172 patients with recurrent condylomata was conducted using systemic interferon alfa-2a in doses of 3 or 9 MIU three times per week for 4 weeks. The treatment period was followed by a treatment-free follow-up period of 2 months. Complete responders at month 3 were followed up to 9 months or until they had a recurrence, whichever occurred first. The combined rates of complete response (total disappearance of all lesions without appearance of new ones) and major incomplete response (at least a 75% reduction in total lesion area) at 3 months after the commencement of therapy were 34%, 25%, and 30%, respectively, in 166 patients receiving 3 and 9 MIU of interferon alfa-2a and placebo. The recurrence rates at the end of 9 months were 9% in the placebo and 3-MIU groups and 36% in the 9-MIU group. We conclude that systemic interferon alfa-2a administered three times weekly for 4 weeks at doses of 3 and 9 MIU is not effective as monotherapy for genital warts that have recurred after standard ablative therapy.
An evaluation of pulse oximetry in prehospital care. STUDY OBJECTIVES: We performed this study to evaluate the accuracy of pulse oximetry oxygen saturation (SpO2) against direct measurements of arterial oxygen saturation (SaO2) in the field. DESIGN: Prospective, cross-sectional, paired measurements of SpO2 against SaO2. SETTING: This evaluation was done in the prehospital setting. INTERVENTIONS: A pulse oximeter with digital probe was used to measure SpO2 in 30 patients. Arterial blood gases were drawn in the field while the pulse oximeter was in use, and oxygen saturation (HbO2) was measured by CO-oximetry. MAIN RESULTS: There was no significant difference between SpO2 (94.6 +/- 5.4%) and HbO2 (94.9 +/- 5.1%) (P = .495, beta less than .2). There was a strong correlation between SpO2 and HbO2 (r = .898). The bias between SpO2 and HbO2 was -0.3, with a precision of 2.4. When SpO2 was 88% or more, HbO2 was 90% or more in every case. Mean carboxyhemoglobin was 1.3 +/- 0.9%, and mean methemoglobin was 0.9 +/- 0.3%. There was no significant difference between the pulse oximeter heart rate and the ECG heart rate (P = .223, beta less than .2). CONCLUSION: We conclude that pulse oximetry is sufficiently accurate to be useful in the field when SpO2 is more than 88%. It is potentially useful in patients with clinical signs of acute hypoxemia and in patients receiving interventions that may produce acute hypoxemia. Further work is needed to evaluate the accuracy of pulse oximetry in the settings of elevated carboxyhemoglobin, methemoglobin, and very low saturations.