shukoor65/lab-rag-model huggingface dataset:
Evaluation of pulmonary venous flow by transesophageal echocardiography in subjects with a normal heart: comparison with transthoracic echocardiography Nineteen normal subjects and five patients with atrial fibrillation underwent transesophageal and transthoracic echocardiographic studies to evaluate the normal pulmonary venous flow pattern, compare right and left pulmonary venous flow and assess the effect of sample volume location on pulmonary venous flow velocities. Best quality tracings were obtained by transesophageal echocardiography. Anterograde flow during systole and diastole was observed in all patients by both techniques. Reversed flow during atrial contraction was observed with transesophageal echocardiography in 18 of the 19 subjects in normal sinus rhythm, but in only 7 subjects with transthoracic echocardiography. Two forward peaks during ventricular systole were clearly identified in 14 subjects (73%) with transesophageal echocardiography, but in none with the transthoracic technique. The early systolic wave immediately followed the reversed flow during atrial contraction and was strongly related to the timing of atrial contraction (r = 0.78; p less than 0.001), but not to the timing of ventricular contraction, and appeared to be secondary to atrial relaxation. Conversely, the late systolic wave was temporally related to ventricular ejection (r = 0.66; p less than 0.001), peaking 100 ms before the end of the aortic valve closure and was unrelated to atrial contraction time. Quantitatively, significantly higher peak systolic flow velocities were obtained in the left upper pulmonary vein compared with the right upper pulmonary vein (60 +/- 17 vs. 52 +/- 15 cm/s; p less than 0.05) and by transesophageal echocardiography compared with transthoracic studies (60 +/- 17 vs. 50 +/- 14 cm/s; p less than 0.05). Increasing depth of interrogation beyond 1 cm from the vein orifice resulted in a significant decrease in the number of interpretable tracings.
Local cardiac responses--alternative methods of control. Much attention has been paid to the influence of the beta-adrenoceptor system on cardiac function in heart failure. Full agonists and partial agonists acting on cardiac beta 1 receptors have been widely investigated, as has the density of these receptors in the failing heart. However, other cardiac control mechanisms may play important roles in the normal heart as well as in heart failure. The Frank-Starling mechanism of enhanced cardiac contraction produced by mechanical stretching of the ventricular myofibrils is well known. When treating patients with heart failure with diuretics, vasodilators and other drugs that influence preload, it is important to consider their overall effects in relation to the Starling curves. Atrial stretching also produces compensatory responses which are currently being intensively studied. Reflex release of atrial natriuretic factor after stimulation of atrial receptors has important physiologic effects in heart failure. The atria, but not the ventricles, are innervated by the vagus; the influence of the parasympathetic nervous system on the heart and circulation is often overlooked. The initial increase in heart rate during exercise is primarily due to withdrawal of vagal influence. Besides acetylcholine, the parasympathetic transmitter, many other local hormones may affect cardiac function; these include prostaglandins, 5-hydroxytryptamine and histamine. Although the activity of the sympathetic nervous system is mediated primarily through beta 1 adrenoceptors, both beta 2 and alpha receptors are also found in the heart. Myocardial alpha 1 receptors, which mediate a positive inotropic effect, have been identified, and prejunctional alpha 2 receptors may mediate inhibition of norepinephrine release from sympathetic nerves.
Quantitative bone and 67Ga scintigraphy in the differentiation of necrotizing external otitis from severe external otitis. Qualitative technetium Tc 99m bone scintigraphy using phosphate compounds and gallium 67 scintigraphy were described as a helpful means in diagnosing necrotizing external otitis (NEO). They were, however, claimed to be nonspecific. Quantitative Tc 99m methylene diphosphonate bone scintigraphy and gallium 67 scintigraphy were performed in eight patients with NEO and in 20 patients with severe external otitis, in order to prove usefulness of scintigraphy in the diagnosis of NEO. Ratios of lesion to nonlesion for bone scintigraphy were 1.67 +/- 0.16 in patients with NEO and 1.08 +/- 0.09 in patients with severe external otitis, and for gallium 67 scintigraphy they were 1.35 +/- 0.24 in NEO patients and 1.05 +/- 0.03 in patients with severe external otitis. There was no difference in uptake between diabetic patients with severe external otitis and nondiabetic patients. The scintigraphic studies were also evaluated using a qualitative scoring method (scores 0 to +4), according to the intensity of the radiopharmaceutical uptake. This method was found to be inferior in the diagnosis of NEO compared with the quantitative method. We conclude that lesion-to-nonlesion ratios greater than 1.5 and 1.3 on bone and gallium 67 scintigraphy, respectively, are indicative of NEO. Quantitative bone scintigraphy, which is quicker to perform, may be used as a single imaging modality for the diagnosis of NEO.
Primary angiosarcoma of the seminal vesicle. We report on an unusual case of primary angiosarcoma of the seminal vesicle. Diagnosis was confirmed by light and electron microscopy, as well as specific immunohistochemical staining. This rare tumor is highly aggressive, and refractory to traditional surgical and adjuvant therapeutic modalities. Sarcomatous lesions of the seminal vesicle are reviewed.
Human T-lymphotropic virus type I screening in volunteer blood donors--United States, 1989. On November 29, 19898, the Food and Drug Administration (FDA) issued recommendations to screen all whole blood donations in the United States for human T-lymphotropic virus type I (HTLV-1). This report summarizes results of the first 13 months of screening (December 1988 through December 1989) by the American Red Cross (ARC) and the Council of Community Blood Centers (CCBC).
Duodenal ulcer and Sjogren's syndrome in patients with primary biliary cirrhosis: a casual association? Peptic ulcer has been reported in patients with primary biliary cirrhosis (PBC), but its frequency and pathogenesis are still poorly defined. We have analyzed the occurrence of duodenal ulcer in 37 female patients affected by PBC and in 35 with chronic liver disease of various etiologies. An active ulcer was found in seven patients with PBC and in one with chronic autoimmune hepatitis. The presence of an exocrine gland defect, as indicated by clinical signs of Sjogren's syndrome (SS), was found in six patients with PBC and duodenal ulcer (85%), but in only eight (26.6%) of those without ulcer (p less than 0.02). Therefore, in our patients, duodenal ulcer occurs more often in PBC than in other types of chronic liver disease. The association of SS with PBC, significantly higher in patients with than without ulcer, supports the hypothesis that the underlying exocrine gland defect is involved in the development of duodenal ulcer.
Zollinger-Ellison syndrome. As clinical experience with patients with ZES has grown, increasing recognition has been made of the broad spectrum of symptoms associated with gastrinomas. Diarrhea and acid-induced esophageal injury have taken their place alongside chronic peptic ulcer disease as indications for screening for gastrinoma. Diagnostic testing should begin with fasting serum gastrin levels and should include intravenous secretin infusion if fasting serum levels of gastrin are nondiagnostic and the patient is not found to be hypochlorhydric. Tumor localization is critical to aid in the identification of patients with potentially curable localized disease. Preoperative evaluation utilizing CT scanning with intravenous contrast should be done early and should be supplemented by other imaging modalities as necessary. Exploratory laparotomy, including a thorough examination of the duodenum and perhaps intraoperative ultrasound, should be performed in all patients with sporadic gastrinoma who lack evidence of extensive metastatic disease on preoperative evaluation. By utilizing this approach, it is likely that at least 20% of patients with ZES can be cured. With the availability of the highly effective H(+)-K(+)-ATPase inhibitor omeprazole, excellent control of symptoms related to gastric acid hypersecretion can be expected. Patients with unresectable gastrinoma may thus avoid potentially morbid antisecretory surgery and be managed with a fairly simple medical regimen. Further developments in the chemotherapeutic management of these patients with unresectable disease should be forthcoming in the future.
Cytomegalovirus appendicitis in a patient with acquired immune deficiency syndrome. We report a homosexual patient with the acquired immune deficiency syndrome (AIDS) and histopathologic evidence for cytomegalovirus (CMV) appendicitis in a patient with no prior history of CMV infection. The patient presented with right lower quadrant pain and intermittent fevers. The diagnosis of appendicitis was difficult to make in this patient because of the presumptive diagnosis of tuberculosis ileitis and the frequent presentation of abdominal pain with fever in AIDS patients. Although CMV colitis is frequently seen in AIDS patients, the prevalence of CMV appendicitis is exceedingly rare. The problems related to making a diagnosis of CMV appendicitis and the therapeutic management of CMV infections are reviewed.
Ten years after cryosurgical treatment of cervical intraepithelial neoplasia. From 1974 to 1977 we treated 96 patients for grade 2 or 3 cervical intraepithelial neoplasia with cryotherapy. They were monitored for 10 to 14 years with an attendance rate of 98%. Treatment resulted in cure in 92%. Nine patients had persisting lesions, and three patients had a recurrent lesion. The last recurrence was diagnosed 6.7 years after cryotherapy.
Use of fluorescent in situ hybridization for marker chromosome identification in congenital and neoplastic disorders. Identifying marker chromosomes of unknown origin in the clinical cytogenetics laboratory has been a problem historically, despite advances in specialized staining techniques. Determination of the origin of these marker chromosomes in patients with congenital or malignant neoplastic disorders is essential for more complete diagnosis, counseling, and treatment. The authors describe the use of fluorescent in situ hybridization with chromosome-specific alpha-satellite DNA probes to identify the origin of marker chromosomes in two patients with congenital disorders and three patients with malignant neoplastic disorders. The impact of firm identification of the marker chromosome for the diagnosis of these patients is discussed. The authors also discuss the feasibility of using this technique routinely in the clinical cytogenetics laboratory.
Milrinone, a bridge to heart transplantation. We describe the use of a milrinone infusion as a bridge to heart transplantation in the treatment of severe congestive cardiac failure secondary to viral cardiomyopathy. The clinical improvement that occurred when milrinone was commenced made it possible to wean the patient from conventional cardiovascular support with an intra-aortic balloon pump and dobutamine. There was an improvement in organ perfusion.
In situ evidence for HPV 16, 18, 33 integration in cervical squamous cell cancer in Britain and South Africa. In a previous study three types of HPV signal were described in CIN. It was suggested that a type 1 signal represented episomal HPV while a type 2 signal represented integrated HPV; and a type 3 signal was indicative of both episomal and integrated HPV. To test this hypothesis 91 squamous cell cancers (SCC) of the cervix from Britain and South Africa were examined for HPV 6, 11, 16, 18, 31, 33, 35. Of the South African group (n = 69) 64% contained HPV types 16 (n = 29) and 18 (n = 15). The SCC in the British group (n = 22) contained HPV 16 and HPV 33 in 12 and three cases, respectively. Of the HPV positive biopsy specimens, 86% showed a type 2 signal in keratinising and non-keratinising tumours and the remainder a type 3 signal. Type 3 signal was present only in keratinising tumours. The presence of punctate signal in 100% of HPV containing SCC, together with localisation of HPV signal to sister chromatids in tumour cell mitotic figures in vivo, provides further evidence for type 2, and the punctate component of type 3 signal representing viral integration.
Changes in the serum levels of CK-MB, LDH, LDH1, SGOT and myoglobin due to cardiac surgery. Elevation of serum levels of enzymes due to myocardial necrosis is considered to be a specific finding for myocardial infarction. This study was designed to determine the changes in the levels of LDH, SGOT enzymes, LDH1, CK-MB isoenzymes and myoglobin in patients who have had coronary bypass grafting and who have had atriotomy for surgical correction without any evidence of myocardial infarction diagnosed by clinical, hemodynamic and electrocardiographic findings. It was found that CK-MB, LDH, LDH1 and myoglobin showed significant elevations which mimicked a perioperative myocardial infarction. SGOT also increased, but remained within the normal range. CK-MB, LDH and LDH1 increased more in the coronary bypass grafted patients whereas myoglobin increased in the patients who had atriotomies. It was concluded that in order to demonstrate a perioperative myocardial infarction it is necessary to determine at least two of these enzymes for a long period and to correlate these results with the clinical, hemodynamic and electrocardiographic findings.
Unusual presentations of duodenal tuberculosis. Gastrointestinal tuberculosis is still rampant in underdeveloped countries and can mimic other gastrointestinal (GI) disorders. Herein we report four cases of isolated proximal duodenal tuberculosis, without involvement of other parts of the GI tract. The clinical presentation in three of them resembled that of peptic ulcer disease, and one had features of gastric outlet obstruction. On investigation, one of these patients had a pyeloduodenal fistula. The limitations of clinical evaluation, radiology, and endoscopy are stressed, and the value of surgical biopsy is highlighted.
Antegrade approach to radical retropubic prostatectomy in patients with difficult apical dissection. Among 335 radical retropubic prostatectomies an antegrade dissection was used in 30 because of difficulty in developing the usual planes of dissection during apical dissection. The adequacy of tumor resection, preservation of sexual potency and urinary continence were compared in patients who underwent the antegrade dissection and those who underwent the standard retrograde nerve-sparing radical retropubic prostatectomy. Histopathological evaluation revealed no significant difference in the over-all completeness of tumor excision between the group having an antegrade dissection (16 of 30, 53% completely excised) and those having a retrograde dissection (177 of 305, 58% completely excised) (p = 0.62). Patients with clinically localized but pathological stage C disease undergoing an antegrade dissection and a nerve-sparing procedure had a significantly higher incidence of positive lateral margins (9 of 12, 75%) than the comparable group undergoing a retrograde dissection (40 of 99, 40%) (p = 0.02). The incidence of positive apical margins was similar in both groups, with 5 of 14 (36%) of the antegrade stage C cases (36%) having positive apical margins compared to 37 of 117 of the retrograde stage C cases (32%) (p = 0.65). Sexual potency was preserved in 5 of 6 patients (83%) treated with an antegrade dissection who had both neurovascular bundles preserved and were followed for at least 6 months, compared to 86 of 142 (61%) who underwent retrograde dissection (difference not significant, p = 0.26). Potency was preserved in 6 of 13 evaluable patients (46%) undergoing unilateral antegrade nerve-sparing procedure compared to 21 of 48 evaluable patients (44%) undergoing unilateral retrograde nerve-sparing procedure (p = 0.88). Of 22 patients followed for 1 year 21 (95%) have regained urinary continence. We conclude that the antegrade approach to radical retropubic prostatectomy provides results that are comparable to those achieved with the standard retrograde approach but that when an antegrade approach is chosen because of periprostatic fibrosis, bilateral preservation of the neurovascular bundles may result in a higher incidence of positive surgical margins.
Asthma in the emergency department: impact of a protocol on optimizing therapy. The objective of this study was to evaluate the impact of a simple educational intervention on the prescribing habits of internal medicine residents in the treatment of acute asthma in a busy emergency department (ED). Prescribing habits for 16 residents were documented for 4 months. The first 2 months served as a control period during which eight residents managed asthma patients without the benefit of any specific educational intervention beyond standard department protocols. A total of 129 patients treated by the residents during this initial phase were assessed. During the second 2-month period, a 10-minute verbal presentation and explicit written treatment protocol were provided to another eight residents, and their treatment of 83 patients was covertly evaluated. Increased prescribing of desired therapy was significantly improved in every area except that of prescribing an inhaled steroid metered dose inhaler for use as a discharge medication. The 10-minute verbal presentation given in conjunction with a three-page handout was found to be highly effective for eliciting improvement in treatment practices during short clinical rotations. The duration of this effect beyond each rotation is unknown. This educational intervention should be presented by the ED medical director, clinical pharmacist, or other appropriate clinician in virtually any ED as quality of patient care can be dramatically improved.
Quality of life after proctocolectomy. A comparison of Brooke ileostomy, Kock pouch, and ileal pouch-anal anastomosis. Recent work has shown that patients undergoing proctocolectomy and ileal pouch-anal anastomosis experience a better quality of life than those undergoing proctocolectomy and Brooke ileostomy. To assess whether the improvement with the pouch is due to the absence of a stoma or the preservation of fecal continence, functional and performance activities were assessed in 406 patients with Brooke ileostomies (stoma present, incontinent), 313 with Kock pouches (stoma present, continent), and 298 with ileal pouch-anal anastomoses (stoma absent, continent). All patients underwent proctocolectomy for ulcerative colitis or familial adenomatous polyposis. After adjusting for age, sex, diagnosis, attitude towards the operation, dietary satisfaction, and ability to work, the likelihood of an impact on performance was estimated for the three types of operation using logistic regression analysis. Patients with ileal pouch-anal anastomoses had fewer restrictions in sports and sexual activities than those with Kock pouches (P less than 0.05), whereas those with Kock pouches in turn had fewer restrictions in these activities but more restrictions in travel than those with Brooke ileostomies (P less than 0.05). In contrast, performance in the categories of social life, recreation, work, and family was similar between groups. It is concluded that both the presence of a stoma and fecal incontinence impair the quality of life after proctocolectomy. Ileal pouch-anal anastomosis, which avoids both stoma and incontinence, offers the best quality of life between the three operations studied.
Optimum dosage of 5-aminosalicylic acid as rectal enemas in patients with active ulcerative colitis. 5-Aminosalicylic acid (5-ASA), the active moiety of sulphasalazine (SASP), was given as a rectal enema to patients with mild to moderate distal ulcerative colitis to determine the minimum effective dosage. A double blind study was carried out using enemas containing 1, 2, or 4 g or 5-ASA or placebo for a one month treatment period. One hundred and thirteen patients with ulcerative colitis attending our outpatient clinic volunteered to participate. Clinical, sigmoidoscopic, and histological assessments were carried out at the beginning of the study and after 15 and 30 days of treatment. All patients who received 5-ASA enemas showed significantly better results than those who received a placebo enema (p less than 0.001) but no difference was detected among the patients receiving differing concentrations of 5-ASA. This study suggests that 1 g 5-ASA (in a 100 ml enema) is a sufficient dosage for patients with a mild to moderate attack of ulcerative colitis.
Enzyme-linked immunosorbent assay of transthyretin devised for semimicro plasma diagnosis of familial amyloidotic polyneuropathy. A highly sensitive and reproducible enzyme-linked immunosorbent assay for human transthyretin was developed. The method is most suitable to serial monitoring of transthyretin peaks in reverse-phase high-performance liquid chromatography for the diagnosis of familial amyloidotic polyneuropathy based on isolation of variant transthyretin. This method semimicronized the original diagnostic method, requiring plasma samples of only 0.2 ml. The present enzyme-linked immunosorbent assay method is also applicable to determine transthyretin in plasma and cerebrospinal fluid. It correlated well when compared with a commercially available single radial immunodiffusion (r = 0.951, p less than 0.001).
Detection of hepatitis B virus pre-S1 and pre-S2 determinants in paraffin wax embedded liver tissue: importance of reagents used. The presence of pre-S polypeptides in paraffin wax embedded liver sections from the biopsy specimens of 15 hepatitis B surface antigen (HBsAg) seropositive patients (five with chronic persistent hepatitis (CPH), four with chronic active hepatitis (CAH), four with cirrhosis and two "healthy" HBsAg carriers) was investigated using monoclonal antibodies directed to distinct epitopes on pre-S1 (18/7 and TO 606) and pre-S2 (5535 and Q 19/10). Pre-S1 was found in 13 cases when MA 18/7 was used but in only one specimen when TO 606 was used. Pre-S2 was detected in all the biopsy specimens with 5535 and in eight samples with Q 19/10. Mild enzymatic digestion annulled the staining of all monoclonal antibodies but Q 19/10. No association was observed between pre-S polypeptide expression and hepatitis B virus (HBV) replication or disease severity. Pre-S polypeptides can be detected readily in paraffin wax embedded material but the results obtained largely depend on the monoclonal antibodies used.
A randomized trial of ofloxacin versus cefoxitin and doxycycline in the outpatient treatment of acute salpingitis. The object of this randomized study was to compare the safety and efficacy of oral ofloxacin, 400 mg twice daily for 10 days, versus intramuscular cefoxitin, 2 gm, plus oral probenecid, 1 gm, followed by oral doxycycline, 100 mg twice daily for 10 days, in the outpatient treatment of uncomplicated acute salpingitis. Thirty-eight women (53%) had Neisseria gonorrhoeae from their pretreatment endocervical or endometrial cultures, and 18 had Chlamydia trachomatis (25%). Thirty-five of 37 women (95%) treated with the ofloxacin regimen were clinically cured, and 34 of 35 (97%) were cured with the cefoxitin-doxycycline regimen (p = 0.52). One clinical failure occurred in each group with N. gonorrhoeae infection, and one failure occurred in the ofloxacin group because of side effects. The bacteriologic response for N. gonorrhoeae in both groups was 100%. The eradication of C. trachomatis was 100% (10/10) for the cefoxitin/doxycycline group and 86% (6/7) for ofloxacin. The side effects were similar in both groups of subjects. In this study both regimens were effective for the outpatient treatment of uncomplicated acute salpingitis.