shukoor65/lab-rag-model huggingface dataset:
The symptomatic os subfibulare. Avulsion fracture of the fibula associated with recurrent instability of the ankle. Four adults who had symptomatic instability of the ankle had an associated os subfibulare. Operative exploration revealed the ossicle to represent a non-union of an avulsion fracture of the anterior talofibular ligament. These findings suggest that an os subfibulare represents an avulsion fracture that may or may not be associated with laxity of the anterior talofibular ligament, rather than being a normal variant.
A novel enzyme immunoassay for serodiagnosis of Helicobacter pylori infection. Helicobacter pylori has recently been implicated as an etiologic agent of gastroduodenal disorders. Comparing the antibody to H. pylori in the sera of patients with that of normal controls by Western blot analysis, a unique antibody was detected in the sera of patients, which reacted with the 25-kilodalton antigen of H. pylori. On the other hand, monoclonal antibody CP3 prepared in the authors' laboratory also recognized the 25-kilodalton antigen of H. pylori. Whether the serum antibody of the patient recognized the CP3 antigen purified by monoclonal antibody CP3 was then examined. Western blot analysis showed that the patient's serum reacted strongly with the affinity-purified CP3 antigen. Using monoclonal antibody CP3, an enzyme-linked immunosorbent assay to detect CP3 antibody in sera was established. In patients with chronic gastritis and gastric ulcers, the titer of CP3 antibody was significantly higher than in normal controls and correlated with the histological grade of antral gastritis. The detection of CP3 antibody in sera is useful in the diagnosis of chronic gastritis and gastric ulcer associated with H. pylori infection and also in evaluation of the grade of gastritis.
Acute short-term memory loss from trimethyltin exposure. We report a case of organic tin exposure in a graduate chemistry student. The inhalational and transcutaneous exposure occurred following a laboratory explosion. The patient initially presented with first and second degree burns of the face and chest, and developed an acute loss of short-term memory 72 hours after exposure. The memory loss gradually improved over the course of several months.
Chronic active Epstein-Barr virus infection and virus-associated hemophagocytic syndrome. We describe two unusual cases of Epstein-Barr virus infection that were complicated by the virus-associated hemophagocytic syndrome, predominantly involving the spleen. Both patients were young adult men who presented with fever, pancytopenia, and hepatosplenomegaly. Both had prompt symptomatic and hematologic improvement following splenectomy. Severe constitutional symptoms recurred in one patient 1 month after splenectomy, and he died of septicemia 2 months later. In both cases, there was prominent hemophagocytosis in the splenic red pulp. Some hemophagocytosis was also noted in the liver from the fatal case. Unexpectedly, no hemophagocytosis was detected in the bone marrow biopsy specimens or marrow aspirates obtained from these patients. The DNA hybridization studies detected Epstein-Barr virus genomes in spleen samples from both patients, and both patients had atypical patterns of serologic response to the virus, suggesting that a defective immune response may lead to an unrestrained viral proliferation. We conclude that there is an association between chronic active Epstein-Barr virus infection and the hemophagocytic syndrome, but that the tissue distribution of the hemophagocytosis may be variable.
Longer relapse-free period after sucralfate than after H2-blocker treatment of duodenal and gastric ulcers. In a prospective investigation of 2,045 patients with recurrent peptic ulcer disease, the relapse-free period after acute treatment with sucralfate was evaluated over 1 year. This remission period was compared retrospectively with that achieved by previous treatment with a histamine-H2-blocker in the same patients. Only patients who had a symptomatic relapse within 1 year after H2-blocker therapy were included. Patients with no relapses within 1 year after sucralfate were assumed to have a relapse on day 366, in order to compare the two periods. In 73% of the evaluable 2,045 patients, remission after sucralfate was longer than after H2-blocker, and 23% of these patients had no symptomatic relapse at all within 1 year after sucralfate. The average relapse-free period after sucralfate was 212 days, as compared with 132 days after H2-blockers (difference = 80 days; p less than 0.0001). Elderly and nonsmoking patients and those experiencing their first recurrence, or who had a duodenal ulcer, benefited especially from acute treatment with sucralfate. It can be concluded that peptic ulcer patients with a relapse after treatment with an H2-blocker are suitable candidates for sucralfate therapy. There is a high probability that the relapse-free period after sucralfate is longer than after H2-blocker treatment in both gastric and duodenal ulcer patients.
Production of interleukin-1 and interleukin-6 by human keratinocytes and squamous cell carcinoma cell lines. Cultured human keratinocytes and squamous cell carcinoma (SCC) cell lines were analyzed for the presence of ribonucleic acid (RNA) transcripts for the cytokines interleukin-1 and interleukin-6 and for these proteins. This study demonstrates that both cytokines are synthesized and secreted by both normal keratinocytes and SCC lines. The rate of secretion of these cytokines can be augmented in response to a variety of stimuli including tumor necrosis factor-alpha, granulocyte-macrophage colony stimulating factor, transforming growth factor-beta and the combination of lipopolysaccharide and phorbol myristate acetate. Interleukin-1 and interleukin-6 have been reported to influence the proliferation of cultured human fibroblasts. However, these cytokines had no significant effect on the proliferation of human keratinocytes or the SCC lines tested. Although it seems unlikely that interleukin-1 or interleukin-6 could directly influence keratinocyte proliferation in vivo, the capacity of these cells to synthesize and release these cytokines supports earlier observations that keratinocytes may play an important role in augmenting an immune or inflammatory response.
PBC 95k, a 95-kilodalton nuclear autoantigen in primary biliary cirrhosis. We have identified a novel antinuclear antibody (ANA) in the sera of patients with primary biliary cirrhosis (PBC). Sera from 22 of 50 PBC patients stained the nuclei of HEp-2 cells in a pattern of 5-20 discrete dots, on indirect immunofluorescence. Typically, the titers were higher than 1:1,280. This staining pattern was seen in only 4 of 1,240 ANA-positive samples from patients with other connective tissue diseases, and in none of the ANA-positive sera from 49 patients with other liver diseases. Sera which stained the nuclear dots bound a 95-kd polypeptide in immunoblots of HeLa nuclei and in immunoprecipitates of 35S-methionine-labeled HeLa extracts. Affinity-purified antibodies from the 95-kd protein reproduced the nuclear dot immunofluorescence staining pattern, demonstrating that this polypeptide is located in the nuclear dots. ANA of this type, therefore, occur in 44% of patients with PBC, and they appear to be specific for PBC. These antibodies bind a 95-kd protein that is discrete and is scattered throughout the nucleus.
The p53 tumour suppressor gene. The cell cycle is composed of a series of steps which can be negatively or positively regulated by various factors. Chief among the negative regulators is the p53 protein. Alteration or inactivation of p53 by mutation, or by its interactions with oncogene products of DNA tumour viruses, can lead to cancer. These mutations seem to be the most common genetic change in human cancers.
Cerebral perfusion during canine hypothermic cardiopulmonary bypass: effect of arterial carbon dioxide tension Cerebral blood flow (radioactive microspheres), intracranial pressure (subdural bolt), and retinal histopathology were examined in 20 dogs undergoing 150 minutes of hypothermic (28 degrees C) cardiopulmonary bypass to compare alpha-stat (arterial carbon dioxide tension, 40 +/- 1 mm Hg; n = 10) and pH-stat (arterial carbon dioxide tension, 61 +/- 1 mm Hg; n = 10) techniques of arterial carbon dioxide tension management. Pump flow (80 mL.kg-1.min-1), mean aortic pressure (78 +/- 2 mm Hg), and hemoglobin level (87 +/- 3 g/L [8.7 +/- 0.3 g/dL]) were maintained constant. During bypass, intracranial pressure progressively increased in the alpha-stat group from 6.0 +/- 1.0 to 13.9 +/- 1.8 mm Hg (p less than 0.05) and in the pH-stat group from 7.7 +/- 1.1 to 14.7 +/- 1.4 mm Hg (p less than 0.05), although there was no evidence of loss of intracranial compliance or intracranial edema formation as assessed by brain water content. With cooling, cerebral blood flow decreased by 56% to 62% in the alpha-stat group (p less than 0.05) and by 48% to 56% in the pH-stat group (p less than 0.05). However, 30 minutes after rewarming to 37 degrees C, cerebral blood flow in both groups failed to increase and remained significantly depressed compared with baseline values. Both groups showed similar amounts of ischemic retinal damage, with degeneration of bipolar cells found in the inner nuclear layer in 67% of animals. We conclude that, independent of the arterial carbon dioxide tension management technique, (1) cerebral perfusion decreased comparably during prolonged hypothermic bypass, (2) intracranial pressure increases progressively, (3) ischemic damage to retinal cells occurs despite maintenance of aortic pressure and flow, and (4) a significant reduction in cerebral perfusion persists after rewarming.
Blindness resulting from orbital complications of sinusitis. Loss of vision remains a potential complication of orbital infection. Appropriate evaluation and management of the patient with signs and symptoms of orbital inflammation may prevent progression to blindness. Evaluation of patients with orbital inflammation from sinusitis includes a comprehensive clinical examination and radiographic studies. Clinical examination should test for changes in visual acuity, pupillary reactivity, and extraocular motion. Computerized tomography (CT) has facilitated the diagnosis of orbital infections and aids in diagnosis. However, CT can be misleading in patients with acute orbital infections and should not be relied on to determine the need for surgical intervention. We reviewed the records of all patients admitted to Parkland Memorial Hospital from 1978 to 1988 with orbital complications resulting from sinusitis. Four of 159 patients in this group had permanent blindness. The presence of an abscess, which was ultimately found at surgical exploration, was not diagnosed by CT in any of these four patients. Clinical examination remains the most important indicator for surgical intervention in patients with orbital complications of sinusitis. We present our findings and give guidelines for surgical intervention in patients with orbital infections resulting from sinusitis.
An outbreak of designer drug--related deaths in Pennsylvania 3-Methylfentanyl ("China White") is a "designer" opiate that has caused more than 100 overdose deaths in California since 1979, but that has not been associated previously with deaths east of the Rocky Mountains. During 1988, 3-methylfentanyl was identified in 16 fatal overdose cases in Allegheny County, Pennsylvania, contributing to a fourfold rise in overdose mortality during October of that year. Morphine was detected in the blood of five persons (31%) and cocaine in the blood of three persons (19%) dying of 3-methylfentanyl overdoses; these were demographically similar to 99 other fatal overdose cases investigated by the county coroner from 1986 through 1988. This documents the contribution of 3-methylfentanyl to overdose mortality in an eastern city and the use of 3-methylfentanyl with other illegal drugs. Drug abusers in the northeastern United States should be considered at risk for more "designer drug" overdose outbreaks in the future.
Serum hepatitis B virus DNA in hepatitis B virus seropositive and seronegative patients with normal liver function. The presence of hepatitis type B virus (HBV) DNA in serum specimens from 926 apparently healthy people with normal liver functions was determined by polymerase chain reaction; 41.2% of people with positive results for HBV surface antigen (HBsAg) (94 of 228) and 95.2% of people with positive results for HBV e antigen (HBeAg) (60 of 63) were found to have positive results for serum HBV DNA. On the other hand, serum HBV DNA was found in 11.0% (77 of 698) of HBsAg-negative people and in 13% (69 of 530) of those who had positive results for serum antibodies directed against HBsAg. The results seem to suggest that HBV DNA can be found in a significant portion of apparently healthy people with normal liver function who are either seronegative for HBsAg or seropositive for antibodies directed against HBsAg.
Posterior spinal fusion in Sotos' syndrome. Sotos' syndrome (synonym: cerebral gigantism) is the association of mental retardation, macrocephaly and prenatal onset of accelerated growth. The rapid skeletal growth may account for a 4% incidence of scoliosis. General anaesthesia using halothane or enflurane in nitrous oxide and oxygen, with opioid supplementation and labetalol to induce moderate hypotension, appeared to be a satisfactory technique for corrective spinal surgery. The potential problems are discussed, with mental retardation and sometimes aggressive behaviour contraindicating a "wake-up" test. Extradural somatosensory evoked potential monitoring is a satisfactory alternative. Hook failures seem more likely than in patients undergoing surgery for adolescent idiopathic scoliosis.
Blood pressure (systolic and diastolic) and risk of fatal coronary heart disease Among the 356,222 men screened for the Multiple Risk Factor Intervention Trial who had no history of hospitalization for heart attack at entry, more than 2,000 coronary deaths occurred during 6 years of follow-up. With this large data set, detailed cross-tabulations clearly and simply showed the strong graded relation between blood pressure and coronary heart disease death. This risk gradient was evident in each of five age groups ranging from 35 to 57 years and for levels of diastolic blood pressure ranging from less than 75 mm Hg to greater than 115 mm Hg. Systolic blood pressure was more strongly associated with coronary heart disease death than was diastolic blood pressure, and isolated systolic blood pressure elevation was found to be an important risk factor in these middle-aged men. The risk of coronary death was increased among hypertensive men who had elevated serum cholesterol levels or who smoked cigarettes. Because less than 10% of hypertensive men had cholesterol levels in the lowest quintile (below 182 mg/dl) and were nonsmokers, a multi-intervention approach for the large majority of hypertensive persons is clearly indicated. Risks of death were also substantially increased among those hypertensive men who already had end-organ damage, emphasizing the importance of early treatment to prevent such damage. These findings have implications for the design of prevention trials and clinical practice, as it is clear that systolic as well as diastolic blood pressure should be considered in treating hypertensive patients. Additionally, treatment goals should be directed at preventing not only death but many other morbid events, clinical and subclinical, that are associated with elevated blood pressure and that are preventable with appropriate treatment.
Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group. 9704 ambulatory women aged 65 years or older were prospectively studied to determine whether low bone mineral density (osteopenia) was associated with mortality. Bone mineral density was measured at entry to the study by single-photon absorptiometry. 299 women died during a mean of 2.8 years' follow-up. Osteopenia was associated with increased non-trauma mortality, probably because it is a marker for several other adverse factors. Each standard deviation decrease in proximal radius bone mineral density (0.104 g/cm2) was associated with a 1.19-fold increase in mortality (95% confidence interval 1.04-1.36), adjusted for age and duration of follow-up. Diminished bone mineral density at the proximal radius was strongly associated with deaths from stroke (relative risk = 1.74; 95% CI 1.12-2.70), an association that was not confounded by history of previous stroke, hypertension, postmenopausal use of oestrogen, thiazide diuretic treatment, diabetes mellitus, and smoking. Most deaths in women with low bone mineral density are unrelated to the occurrence of fractures-an observation that should be taken into account when estimating the need for and cost-effectiveness of bone-density screening and fracture prevention programmes.
Is deleting the digital rectal examination a good idea? Many groups have taken the position that the digital rectal examination should be discontinued as part of the annual screening physical examination. We examined the effects of not doing a digital rectal examination on the early diagnosis of prostate cancer. The average time since a previous rectal examination increased as the stage of cancer increased. The digital rectal examination proved to be a relatively insensitive test, with 40% of stage D cancers being detected initially within 12 months of the most recent examination. Nevertheless, an annual digital rectal examination did detect a greater percentage of lower stage (and thus more localized and potentially curable) cancers when repeated within 12 months. When the last rectal examination was more than 24 months previous, cancers detected were more likely to be advanced. Without a digital rectal examination, patients would have their disease detected only by the presence of symptoms. When it was done because of symptoms, 81% of our patients had stage D cancers compared with 32% of stage B and 38% of stage C patients. Without the routine use of this examination, patients with prostate cancer would be more likely to have higher stage and less potentially curable lesions at the time of diagnosis. We conclude that the digital rectal examination remains an important part of routine annual physical examinations.
Arterial stent placement with use of the Wallstent: midterm results of clinical experience. Self-expandable stents of the Wallstent type were used in 26 iliac and 15 femoropopliteal artery lesions of 31 patients to treat stenoses or occlusions. The indications were confined to complex lesions, including residual stenoses and dissections after percutaneous procedures or previous surgery in the iliac artery lesions, and long-segment (mean, 13.5 cm) occlusions with inadequate response to percutaneous recanalization in the femoropopliteal artery lesions. In the iliac artery group, after stent placement, 96% of the lesions were patent at a mean follow-up of 16 months (range, 6-30 months). In the femoropopliteal artery group, of 11 patients available for follow-up, only six had patent stents at 7-26 months (mean, 20 months). Four of these six patients required one to three secondary interventions. Self-expanding endoprostheses are of great value in complex iliac artery lesions where simple balloon dilation is insufficient. Stent placement for long femoral artery lesions should be performed with utmost reserve, and the extent of stent placement should be as short as possible.
Renal cell carcinoma in young and old patients. Comparison of prognostic pathologic variables (cell type, tumor grade and stage, and DNA ploidy pattern) and their impact on disease outcome. A group of 41 young patients (age less than or equal to 40 years; mean, 35.7 years) and a group of 34 old patients (age greater than or equal to 80 years; mean, 82.4 years) who underwent operation for renal cell carcinoma between 1970 and 1986 were compared. Sex, grade, and DNA ploidy pattern distributions were similar between the groups. Granular cell and papillary cancers with lower stages at presentation were more common among the young. In patients with high-stage disease, 73 percent of the older group but none of the younger had DNA diploid tumors. Low-stage clear cell carcinoma caused cancer death only in the young. Stage I nondiploid clear cell carcinomas were associated with death (33%) only in the young. Overall, death rates seem similar for both groups but among the young most (63%) occurred with low-stage disease and a nondiploid pattern only; among the old, 88 percent occurred with high-stage disease and independent of DNA ploidy pattern.
Complications of pregnancy and delivery in relation to psychosis in adult life: data from the British perinatal mortality survey sample. OBJECTIVE--To evaluate whether events occurring at or around the time of birth contribute to the onset of psychotic illness in adult life. DESIGN-Pregnancy and birth complications as possible causes of adult mental illness were studied in the population sample of the British perinatal mortality survey. Subsequent psychiatric admissions were independently identified through the Mental Health Enquiry and records of regional and special health authorities. Logistic regression was used to compare data on perinatal deaths with those on survivors to determine factors independently associated with perinatal death, and this equation was then used to calculate the risk of perinatal death for each survivor. SUBJECTS--16,980 people born in a single week in 1958 (the British perinatal mortality survey sample), including 252 patients admitted to psychiatric care; case notes of 235 patients were supplied. MAIN OUTCOME MEASURES AND RESULTS--Patients with a schizophrenic illness (whether defined by "broad" (n = 57) or "narrow" (n = 35) diagnostic criteria) did not have a greater mean risk of perinatal death than the population in general, but there was some evidence of increased liability (relative risk 2.43; 95% confidence interval 1.17 to 5.05) for those with affective psychosis (n = 32). Specific high risk variables for affective psychosis were decreased gestation time (273.9 v 281.2 days; mean difference 7.3 days, 95% confidence interval 3.1 to 11.5; p less than 0.002) and prescription of vitamin K to the child in the first week of life (19% of patients v 5% of controls, p = 0.016). CONCLUSIONS--The findings give no support to theories that factors predicting perinatal mortality contribute significantly to causation of schizophrenic illness. Further investigation of decreased gestation length in relation to affective disorder is required.
Cerebrospinal fluid protein and opening pressure in idiopathic intracranial hypertension (pseudotumor cerebri). We studied the relationship between the CSF protein concentration and the degree of elevation of the CSF opening pressure in 177 patients with idiopathic intracranial hypertension (pseudotumor cerebri). There was no linear correlation between the CSF protein and opening pressure. In addition, low CSF protein (less than 20 mg/dl) was present in only 26% of the patients. Our findings fail to confirm previous reports of an inverse relationship between the CSF opening pressure and CSF protein as well as low CSF protein in these patients.
Delayed presentation of a carotid-cavernous sinus fistula in a patient with traumatic brain injury. Carotid-cavernous sinus fistulas are rare complications of traumatic brain injury, facial trauma and postorthognathic surgery. A high level of clinical suspicion is necessary, particularly for patients who are unable to communicate, to establish the diagnosis. A case of delayed presentation of a carotid-cavernous sinus fistula after traumatic brain injury is presented. This case illustrates that early recognition of this disorder is crucial to prevent significant morbidity.