shukoor65/lab-rag-model huggingface dataset:
Echocardiography and Doppler ultrasound in the evaluation of pericardial disease. Echocardiography and Doppler ultrasound are useful in evaluating a variety of pathological conditions affecting the pericardium. Cardiac tamponade results in right atrial collapse and right ventricular diastolic collapse detectable by echocardiography. These echocardiographic signs have a high degree of sensitivity and specificity. False-negative echocardiographic studies may be seen in patients with pulmonary hypertension, and false-positive studies for cardiac tamponade may occur in severe hypovolemia. Although cardiac tamponade is usually caused by pericardial effusion, less commonly intrapericardial clot may result in hemodynamic compromise. Pericardial clot may be echogenic, and hence the diagnosis potentially can be missed. If the intrapericardial clot is localized, the classic echocardiographic signs of pericardial effusion may be absent, and a localized mass may be seen on the echocardiogram. Increased respiratory variation in transvalvular blood flow velocities detectable by Doppler ultrasound is found in cardiac tamponade. Doppler ultrasound studies may be particularly useful in those patients in whom the characteristic echocardiographic abnormalities are absent. Both M-mode and two-dimensional echocardiography may be useful in diagnosing pericardial thickening. Constrictive pericarditis results in a variety of echocardiographic abnormalities including pericardial thickening; biatrial enlargement with good left ventricular function; a diastolic septal bounce; and a dilated inferior vena cava without significant respiratory variation. Doppler echocardiographic abnormalities are commonly found in constrictive pericarditis. Echocardiography is also useful as a guide to performing pericardiocentesis and in the detection of pericardial adhesions and pericardial metastases.
Pericardial actinomycosis: case report and review. Pericardial actinomycosis is rare and frequently goes unrecognized during life, a circumstance due in part to a paucity of clinical manifestations and to a low rate of positivity in cultures. We present a case report of pericardial actinomycosis and a review of 18 other cases reported in the literature since 1950. Possible risk factors include aspiration pneumonia, alcohol abuse, and periodontal disease. Actinomyces may cause purulent pericarditis that evolves into cardiac tamponade or constrictive pericarditis. Clues to the identity of the causative organism (e.g., draining sinus tracts and the presence of sulfur granules) are frequently absent, and cultures often fail to yield the organism. Histologic examination of material obtained by biopsy is often necessary to make the diagnosis. Most cases originate from a thoracopulmonary site of actinomycosis and spread directly to the pericardium. Widespread dissemination to extrathoracic organs is uncommon. Treatment consists of high-dose, long-term antimicrobial therapy as well as drainage of the pericardial space.
Erythropoietin deficiency after coronary artery bypass procedures. Erythropoietin is the primary regulator of erythropoiesis. Erythropoietin has been shown to increase exponentially in response to linear decreases in hematocrit in normal, unstressed animals. However, the effect of operation, with its attendant stress, on erythropoietin levels is unknown. The purpose of this study is to evaluate the effect of surgical stress on erythropoietin. Twenty otherwise healthy patients scheduled for elective surgical procedures were studied. The cholecystectomy group included 10 patients who underwent cholecystectomy for documented stone disease. Ten patients who underwent coronary artery bypass procedures constituted the coronary artery bypass grafting group. Patients were studied preoperatively as well as on the first and second postoperative days. The hematocrit and erythropoietin levels were similar in both groups preoperatively. The hematocrit in the coronary artery bypass grafting group was lower than that of the cholecystectomy group on postoperative day 1 (0.31 versus 0.36; p less than 0.003) and postoperative day 2 (0.30 versus 0.36; p less than 0.001). During the first two postoperative days the erythropoietin levels were similar between groups. The data show that postoperative erythropoietin levels are similar after coronary artery bypass grafting, despite more severe anemia, when compared with cholecystectomy. This suggests that after coronary artery bypass grafting there is a relative deficiency of erythropoietin. Administration of recombinant human erythropoietin to patients undergoing surgical procedures could correct the erythropoietin deficiency and accelerate postoperative erythropoiesis.
Ruling out acute myocardial infarction. A prospective multicenter validation of a 12-hour strategy for patients at low risk BACKGROUND. Although previous investigations have suggested that 24 hours is required to exclude acute myocardial infarction in patients who are admitted to a coronary care unit for the evaluation of acute chest pain, we hypothesized that a 12-hour period might be adequate for patients with a low probability of infarction at the time of admission. METHODS. Using a Bayesian model, we developed a strategy to identify candidates for a shorter period of observation from an analysis of a derivation set of 976 patients with acute chest pain who were admitted to three teaching and four community hospitals. In the derivation set, patients whose clinical characteristics in the emergency room predicted a low (less than or equal to 7 percent) probability of myocardial infarction had only a 0.4 percent risk of infarction if they had neither abnormal levels of cardiac enzymes nor recurrent ischemic pain during the first 12 hours of hospitalization. In an independent testing set of 2684 patients from the seven hospitals, 957 admitted patients (36 percent) were classified as candidates for this 12-hour period of observation according to a previously published multivariate algorithm. Few of these patients were actually transferred from a monitored setting at 12 hours. RESULTS. Of the 771 candidates for a 12-hour period of observation who did not have enzyme abnormalities or recurrent pain during the first 12 hours, 4 (0.5 percent) were subsequently found to have acute myocardial infarction, and only 3 (0.4 percent) died after primary cardiac arrests, all of which occurred three to five days after admission. Rates of other major cardiovascular complications were low in the patients who might have been transferred from the coronary care unit after 12 hours with this strategy. In patients with a higher initial risk of infarction, the standard strategy of 24-hour observation identified all but 11 of 739 acute myocardial infarctions (1 percent). CONCLUSIONS. Emergency room clinical data can be used to identify a large subgroup of patients for whom a 12-hour period of observation is normally sufficient to exclude acute myocardial infarction. Patient-specific evaluation and treatment can then proceed without the restrictions imposed by "rule-out" protocols for myocardial infarction.
Cholesterol screening management of Florida's pediatric population. The current cholesterol screening and management of Florida's pediatric population is evaluated utilizing a questionnaire mailed to 1,534 pediatric health care providers. Twenty percent of the physicians responded. Of the respondents, 65% do not routinely screen for the presence of hypercholesterolemia. Only 28% of the respondents obtain serum total cholesterol measurements in accordance with the American Academy of Pediatrics Committee on Nutrition recommendations. The serum total cholesterol concentration prompting treatment was 240 mg/dL (6.2 mM). Dietary counseling alone, or in combination with exercise, was the initial treatment approach recommended by 98% of the responding physicians. Dietary education for the hypercholesterolemic patient was provided by both dieticians (46%) and physicians (42%). If the initial dietary intervention was unsuccessful, 48% of the physicians would begin medical therapy. The most commonly prescribed medication was a bile acid sequestrant (70%), with the majority (52%) referring their patient to a subspecialist for evaluation and care.
Flashlamp-pumped pulsed dye laser for port-wine stains in infancy: earlier versus later treatment. Twelve children, 6 to 30 weeks of age (average 14.9 weeks), with port-wine stains of the head and neck were treated with the flashlamp-pumped pulsed dye laser at 585 nm and 450 microsecond pulse duration. Ten of 12 patients (83%) showed more than 50% lightening of their port-wine stains after 2.9 treatment sessions (2.9 +/- 1.4 [+/- standard deviation]). Forty-five percent of the patients demonstrated 75% or more lightening of their lesions after a mean of 3.8 treatments (+/- 1.6). No lesions in this group cleared completely after a mean of 2.8 treatments. Treated skin was identical in texture to normal skin in all patients. There was no evidence of depressed scars, atrophy, hyperpigmentation, or hypopigmentation in the treated areas. These results indicate that pulsed dye laser treatment of port-wine stains can be undertaken safely in infancy.
Diffuse melanosis in metastatic malignant melanoma. The skin of a patient with diffuse melanosis as a result of malignant melanoma was examined by light microscopy, immunohistochemistry, and electron microscopy. Our findings indicate that the slate-blue discoloration in this patient was due to pigment deposition in dermal macrophages and endothelial cells. Multiple attempts to identify disseminated metastatic melanoma cells were unsuccessful.
Intraoperative electron beam radiation therapy for primary locally advanced rectal and rectosigmoid carcinoma. To improve local control and survival in patients with primary locally advanced rectal and rectosigmoid carcinoma, intraoperative electron beam radiation therapy (IORT) has been used with a combination of moderate- to high-dose preoperative radiation therapy and surgical resection. Sixty-five patients underwent resection with the intention of using IORT if areas at high risk for local recurrence were apparent at surgery. For 20 patients undergoing complete resection with IORT, the 5-year actuarial local control and disease-free survival (DFS) was 88% and 53%, respectively. The results for 22 patients with pathologically documented residual carcinoma were less satisfactory with a 5-year actuarial local control and DFS of 60% and 32%, respectively. In this latter group, local control and DFS correlated with the extent of residual disease: patients with only microscopic disease had a 5-year actuarial local control and DFS of 69% and 47%, respectively, whereas for patients with macroscopic disease, these figures were 50% and 17%, respectively. For 18 patients undergoing complete resection without IORT or additional postoperative radiation therapy, the 5-year actuarial local control and DFS was 67% and 53%, respectively. Because local failure will occur in at least 30% of patients undergoing partial resection with or without IORT as well as patients undergoing complete resection of advanced tumors without IORT, additional postoperative radiation therapy should be considered.
Parameters for and safety of contact Nd:YAG laser irradiation of early gastric cancer: an in vitro study. Early gastric cancers have been treated by endoscopic contact Nd:YAG laser irradiation. The extent of thermal damage produced by this laser system has been inadequately investigated. In an in vitro study we have shown that contact laser probes produce consistent and reproducible thermal lesions in the human stomach wall. Contact laser energies of 40 to 60 joules are optimal for the ablation of early gastric cancer. Energies greater than 90 joules are associated with a high incidence of gastric perforation. Contact laser probes may have advantages over non-contact laser techniques for the endoscopic treatment of early gastric cancer in patients who are unfit for major surgery.
The pathogenesis of hypertension: black-white differences. In summary, for reasons that are not clear, some persons seem to be extremely good at retaining sodium on a high-sodium diet or poor at excreting sodium on a high-sodium intake. This is more frequent in Western hemisphere blacks than in whites in the West or in blacks in Africa. These geographic/ethnic differences in sodium handling ability may be related to environmental factors or, more likely, to inherited differences in the ability to conserve sodium based on the evolutionary principle of survival fo the fittest for the ability to conserve sodium. The frequency of this salt-conserving (thrifty) genotype in Western hemisphere blacks may have been further increased as a consequence of severe selection pressures for survival based on the ability to conserve sodium during the slavery period of history in the West. One characteristic of the blood pressure control systems of Western hemisphere blacks is suppression of plasma renin activity without suppression of aldosterone production. In addition there is greater nephrosclerosis in blacks than whites and a more rapid decline in creatinine clearance with age. When more sodium is ingested than the kidneys are able to handle (excrete), there is a (transient) slight positive sodium balance; as a result sodium, chloride, and water are retained, resulting in an expansion of plasma volume (Fig. 7-3). The initial physiologic responses include (increased) secretion of atrial natriuretic peptides and the digitalis-like substance (natriuretic hormone), and inhibition of vasopressin and aldosterone secretion. The net effect is directly enhanced natriuresis and diuresis, and a reduction in plasma volume, with no significant effect on blood pressure. However, if there is a continuing tendency to sodium retention and volume expansion, the capacity of the aforementioned mechanisms to control plasma volume will be exceeded; then, the chronically elevated level of the digitalis-like substance will inhibit the sodium pumps in the arterial and venous smooth muscle cells and in the sympathetic neurons. The increased venous tone will help to reduce plasma volume directly by reducing central venous volume. Arterial tone will be increased by direct action of the digitalis-like substance on the arterial smooth muscle and, indirectly, via the hormone's action on the sympathetic neurons. Initially, of course, blood pressure will be maintained in the normal range (but will be labile) because of the compensating cardiovascular reflexes. Once the capacity of these reflexes to control blood pressure is exceeded, however, the blood pressure will begin to rise; this will induce a pressure natriuresis to help restore plasma volume to normal.(ABSTRACT TRUNCATED AT 400 WORDS).
Complications of transurethral electro-incision of posterior urethral valves. The development of dense urethral strictures following transurethral resection of posterior urethral valves is a well known complication, especially in the neonate. In 85 boys with posterior urethral valves no strictures were found during follow-up. Urinary incontinence associated with transurethral incision occurred in 3 patients and a small urethral diverticulum was found in 1. The complication rate associated with the transurethral incision itself was 5%. Our technique for transurethral incision of posterior urethral valves is described.
Is adjuvant chemotherapy necessary for patients with stage B1 testicular cancer? Controversy exists concerning the role of adjunctive chemotherapy in patients with regional nodal involvement. A randomized study reported a 48% relapse rate for patients with positive nodes (stage B1 or stage B2), all of whom were salvaged by full-dose platinum-based chemotherapy. In a series of patients with positive nodes who received two cycles of adjunctive chemotherapy postoperatively, the relapse rate was only 2%. In order to evaluate the effect of retroperitoneal lymph node dissection on relapse rates in patients with stage B1 testicular cancer, a retrospective review of a series of 39 patients was performed. Criteria for inclusion included pathologic stage B1 (less than six positive nodes, located in the primary landing site, with no node greater than 2 cm in diameter and no extracapsular lymph node extension). Patients who fulfilled the criteria along with normalization of tumor markers were followed-up expectantly after retroperitoneal lymph node dissection. Thirty-nine patients were followed from 1 to 10 years with the median duration of follow-up of 3.5 years. Ten of the 39 patients had modified retroperitoneal lymph node dissections with preservation of antegrade ejaculation. The other 29 had full retroperitoneal lymph node dissections. Three relapses were seen, one patient with retrocrural and pulmonary metastases and two patients with pulmonary metastases only for a relapse rate of 8% (three of 39). Patients with stage B2 disease received adjunctive chemotherapy with two or three cycles of platinum-based chemotherapy. We conclude that retroperitoneal lymph node dissection alone is adequate treatment for the majority of patients with pathologic stage B1 testicular cancer. In that subset of patients, adjunctive chemotherapy should be reserved for relapse.
Recurrent spinal cord tethering by sacral nerve root following lipomyelomeningocele surgery. Case report. A 21-year-old woman had recurrent progressive weakness/hypesthesia and pain in both lower extremities. At the age of 5 and 19 years, she had undergone surgical resection of a lipomyelomeningocele at L5-S1. Surgical exploration revealed that the cord was tethered and pulled over to the side by an excessively short right S-1 nerve root. The contralateral L-5 and S-1 nerve roots were markedly stretched. Division of the right S-1 nerve root resulted in prompt disappearance of pain in the lower extremities and improvement in neurological function.
Cancer incidence following subtotal gastrectomy. Hawaiian Japanese men (n = 432) who had undergone subtotal gastrectomy for peptic ulcers before 1971-1975 were followed up for detection of cancer development. They showed a significant increase in colon cancer risk (P = 0.008) and lung cancer risk (P = 0.002) compared with 6161 nongastrectomized men. The association with lung cancer persisted after adjustment for cigarette use (P = 0.03). Alcohol consumption was associated with colonic cancer in this cohort, and gastrectomized men consumed more alcohol than nongastrectomized men; however, the association of gastrectomy with colon cancer persisted after adjustment for alcohol use (P = 0.02). Gastrectomized men were lighter and had lower serum lipid levels than controls, suggesting that undernutrition might favor the development of some cancers. The type of gastroenteric anastomosis did not influence the cancer risk level in the colon or lung.
Reasons for the lack of benefit of immediate angioplasty during recombinant tissue plasminogen activator therapy for acute myocardial infarction: a regional wall motion analysis. European Cooperative Study Group. Regional ventricular wall motion analysis utilizing three different methods was performed on predischarge left ventriculograms from 291 of 367 patients enrolled in a randomized trial of single chain recombinant tissue-type plasminogen activator (rt-PA), aspirin and heparin with and without immediate angioplasty in patients with acute myocardial infarction. With univariate analysis, no difference in regional wall motion variables between the two treatment groups was observed. However, with individual baseline risk assessment by multivariate linear regression analysis using baseline characteristics known to be related to left ventricular function after thrombolytic therapy or outcome of coronary angioplasty, or both, an excess of high risk patients in the invasive treatment group was detected. To adjust for this unequal distribution of baseline risk, multivariate linear regression analysis was performed. No benefit of immediate coronary angioplasty was observed after adjustment. Reocclusion or reinfarction, or both, occurred more frequently in the invasive than in the noninvasive treatment group (18% versus 13%, respectively). Among patients with a patent infarct-related vessel on angiography between days 10 and 22 and without reinfarction before angiography, there was a trend toward benefit from the invasive strategy, indicating that reocclusion and reinfarction might be responsible for the lack of benefit of the invasive strategy. This implies that immediate coronary angioplasty may be beneficial in selected patients, provided that these complications can be prevented.
Percutaneous ethanol injection therapy of hepatocellular carcinoma: analysis of 77 patients. Although sonographically guided percutaneous ethanol injection therapy has been attracting a great deal of attention in the treatment of liver neoplasms, few reports regarding long-term results of this therapy have been published. We report here our 4-year experience, in which ethanol injection was performed 419 times on 108 lesions in 77 patients with hepatocellular carcinoma. Histopathologic examination performed in 14 cases after the therapy revealed that the lesion was completely necrotic in 10 cases, 90% necrotic in three cases, and 70% necrotic in the remaining case. Angiography performed after the therapy showed complete disappearance of tumor stain in 37 of 42 cases treated with ethanol injection. CT after the therapy showed no enhancement of the treated lesion in 55 of 56 cases. Elevated serum levels of alpha-fetoprotein decreased in 21 of 24 cases. Ethanol injection improved the long-term prognosis of the patients. Among the 50 patients in whom there were three or fewer lesions and all lesions were treated by ethanol injection, the 1-, 2-, 3-, and 4-year survival rates were 89%, 74%, 68%, and 60%, respectively. Factors that significantly affected the prognosis were the goal of the treatment, liver function, and size of the largest lesion. Serious complications rarely occurred even in patients with severe liver dysfunction. Percutaneous ethanol injection therapy appears to be valuable for treatment of hepatocellular carcinoma.