shukoor65/lab-rag-model huggingface dataset:
Hypertrophic cardiomyopathy characterized by marked hypertrophy of the posterior left ventricular free wall: significance and clinical implications. This report describes a subgroup of 17 patients with hypertrophic cardiomyopathy and an unusual and distinctive pattern of left ventricular hypertrophy characterized on echocardiography by marked thickening of the posterior left ventricular free wall and virtually normal or only modestly increased ventricular septal thickness. This distribution of hypertrophy often created a distinctive pattern of "inverted" asymmetry of the posterior wall relative to the septum. The thickness of the posterior wall was 20 to 42 mm (mean 25), while that of the basal ventricular septum was only 12 to 24 mm (mean 17). The left ventricular outflow tract was narrowed because of anterior displacement of the mitral valve within the small left ventricular cavity. Systolic anterior motion of the mitral valve was present in 16 of the 17 patients. The patients ranged in age from 13 to 54 years (mean 31) at most recent evaluation; most (11 of 17, 65%) were severely symptomatic and had experienced important symptoms early in life (before age 40). The condition of only 4 of these 11 patients improved with medical therapy over an average follow-up period of 9 years; however, 6 of the 7 patients who had unsuccessful medical treatment and underwent operation with mitral valve replacement (5 patients) or ventricular septal myotomy-myectomy (1 patient) experienced symptomatic benefit from surgery. The subgroup of patients described in this report underscores the morphologic and clinical diversity that exists within the overall disease spectrum of hypertrophic cardiomyopathy. Characteristically, the patients were young, severely symptomatic and demonstrated evidence of outflow obstruction and an "inverted" asymmetric pattern of posterior free wall left ventricular hypertrophy.
Neuropsychiatric aspects of psychogenic status epilepticus. We studied 20 patients with continuous repetitive psychogenic seizures simulating status epilepticus. Most patients received intravenous doses of multiple anticonvulsants. Our definition used for status epilepticus was that of Delgado-Escueta et al, at least 30 minutes of repetitive seizures without regaining consciousness. Nineteen of 20 patients were young women, all but one under 40 years of age. Sixteen of these patients had a history of childhood seizures. In over 50% of patients, seizures continued until respiratory arrest and intubation occurred. Thorough neuropsychological testing and psychiatric interview were done after cessation of the acute episode. Long-term outcome and prognosis depended on definitive psychiatric diagnosis. Repetitive psychogenic seizures simulating status epilepticus are not uncommon, and such patients may incur serious iatrogenic complications from treatment for status epilepticus. Appropriate management and long-term prognosis may be determined by the type and severity of the underlying psychiatric disorder.
Expression of a cell adhesion protein (VLA beta) in normal and diseased skin. Biopsies from normal skin (n = 17) and various cutaneous disorders (n = 83) were examined immunohistologically for reactivity with an antibody (CD29) against the common beta chain of the VLA integrin family. In normal skin, CD29 recognized a number of cell types, i.e. endothelial cells, fibroblasts, T lymphocytes and basal keratinocytes. Similar cells were positive in diseased skin, but the expression of VLA beta was upregulated on keratinocytes. The phenotype of the VLA beta-positive T cells was examined in more detail by staining with anti-T-cell antibodies, i.e. CD3, CD4, CD8, CD45RO (UCHL1) and CD45R (2H4). These studies showed that most of the T cells in normal skin, benign cutaneous conditions and early cutaneous T-cell lymphomas (CTCL) expressed a similar phenotype and resembled antigen committed 'memory' (helper/inducer) cells (CD4+, CD29+, CD45RO+, CD45R-). In advanced CTCL, expression of these antigens was more variable, and many of these infiltrates showed aberrant (or unusual) expression of CD29, CD45RO, CD45R and other T-cell antigens. It is concluded that several cells involved in cutaneous immune reactions express a molecule (VLA beta) which acts as a receptor for extracellular matrix components. This molecule is important for the attachment of cells to connective tissue constituents and may act to facilitate the migration of lymphocytes (and other cells) during immune reactions in normal and diseased cutaneous conditions. Advanced CTCL differ from the early lesions and it is possible that there is a progressive accumulation of increasingly malignant (or transformed) cells in these conditions.
Lipid cyst: classic and atypical appearances. Lipid cysts, a specific type of fat necrosis, frequently have a pathognomonic appearance on radiographs. This consists of a lucent lesion surrounded by a smooth rim that may or not be calcified. Occasionally, lipid cysts with unusual mammographic appearances are encountered. An appreciation of some of these appearances may prevent unnecessary biopsies.
Predictors of first discharge and subsequent survival in patients with automatic implantable cardioverter-defibrillators. BACKGROUND. Two hundred eighteen patients were evaluated in a two-phase approach (time to first appropriate discharge, survival after discharge) to identify factors that may be related to maximal benefit derived from use of an automatic implantable cardioverter-defibrillator (AICD). METHODS AND RESULTS. One hundred ninety-seven patients survived implantation of AICD, with or without concomitant cardiac surgery. One hundred five patients had an AICD discharge associated with syncope, presyncope, documented sustained ventricular tachycardia or fibrillation, or sleep at 9.1 +/- 11.1 months after implantation. Patients survived 23.8 +/- 18.0 months after AICD discharge. Left ventricular dysfunction (p = 0.008 for ejection fraction less than 25%) was associated with earlier AICD discharge and shortened survival after AICD discharge (p = 0.008 for ejection fraction less than 25%; p = 0.01 for New York Heart Association functional class III and IV). beta-Blocker administration (p = 0.006) and coronary bypass surgery (p = 0.06) were associated with later AICD discharge. Coronary bypass surgery (p = 0.035) but not beta-blockers was associated with more prolonged survival after AICD discharge. CONCLUSIONS. These data suggest that a relatively easy algorithm can be applied to predict which patient will benefit most from AICD implantation.
Amsacrine is safe and effective therapy for patients with myocardial dysfunction and acute leukemia. The role of amsacrine in inducing remission in patients with cardiac disease and acute leukemia was evaluated. There were 17 patients with acute myelogenous leukemia (AML), six with acute lymphocytic leukemia (ALL), and one with biphenotypic leukemia. In this series of 24 patients whose disease had relapsed and who had reduced left ventricular ejection fraction, nine had a complete remission, seven with AML and two with ALL. In addition, four of six with newly diagnosed acute leukemia and reduced left ventricular ejection fraction also responded. Among nine patients who underwent endomyocardial biopsy, none had morphologic changes of sufficient degree to account for drug-induced heart failure. Patients with preexisting arrhythmias received amsacrine without incident if their serum potassium level was higher than 4.0 mEq/l at the time of drug administration. Amsacrine is safe and effective therapy for patients with acute leukemia and cardiac disease.
New technique for pacemaker implantation in the upper chest of children and women. A new lateral approach for implanting pacemaker generators in the chest of women and children is described. Using this technique, 83 women and 21 children were operated on with no early or late complications and with good cosmetic results up to 9 years after operation. This technique prevents formation of visible wide scars above the breast in women and prevents thinning or disruption of the chest incision in children. Ages of the women ranged from 19 to 56 years; children, 5 to 18 years. In 23 patients, this technique was used after wound complications had occurred 7 days to 3 years after use of the standard implantation technique.
Flow-mediated dilatation of the basilar artery in vivo. Flow-mediated dilatation has been described mainly in peripheral conduit arteries. The goal of this study was to examine mechanisms and functional implications of flow-mediated dilatation in large cerebral arteries in vivo. Vessel diameter and velocity of blood flow through the basilar artery were measured using a cranial window in 45 anesthetized rats. Mean blood flow velocity through the basilar artery increased by 94 +/- 8% during unilateral common carotid artery occlusion and 203 +/- 13% during bilateral occlusion. Diameter of the basilar artery increased by 10 +/- 1% during unilateral common carotid artery occlusion and 29 +/- 2% during bilateral occlusion from control diameter of 275 +/- 8 microns. Vasodilatation appeared with a delay of 13 +/- 1 seconds after the onset of the increase in flow velocity. With systemic arterial pressure maintained at baseline levels, pressure in the basilar artery (servonull) decreased initially during carotid occlusion, and during dilatation of the basilar artery, pressure was restored partially toward normal. Indomethacin (10 mg/kg i.v.), topical application of tetrodotoxin (10(-6) M), NG-monomethyl L-arginine (5 x 10(-6) M), tetraethylammonium chloride (10(-2) M), glibenclamide (10(-5) M), SKF 525A (3 x 10(-5) M), and ouabain (10(-5) M) had no effect on flow-mediated dilatation.
Minor contribution of hepatocytes to collagen production in normal and early fibrotic rat livers. Hepatocyte contribution to hepatic collagen production in vivo was estimated in rats, based on the fact that ornithine is used for protein synthesis in the liver as arginine after conversion by way of the urea cycle only by hepatocytes. From rats given a mixture of [14C] ornithine and [3H]arginine, hepatic collagen and serum albumin were obtained. The hepatocyte contribution was calculated from the 14C and 3H in arginine purified from collagen and albumin by high performance liquid chromatography. The contribution was less than 10% of total collagen production in normal and early fibrotic livers induced by a single dose of carbon tetrachloride or dimethylnitrosamine. We conclude that hepatocytes may play a minor role in collagen production in normal and early fibrotic rat livers.
Childhood blindness in the Republic of Ireland: a national survey. We completed a national study of blindness in children under 16. Approximately 80% of the blind children (that is, with vision of 3/60 or less) in the Republic of Ireland (172 children) were seen, 93 males and 79 females. The survey was carried out between July 1989 and June 1990. It is the first such study to be carried out. Ninety seven (56%) children had lesions due to factors acting before the perinatal period. Of these, 28 (16% of the total number surveyed) had lesions due to genetic causes; 69 (40%) had lesions due to factors operating in the prenatal period other than genetic factors. Forty six (27%) had lesions due to factors acting in the perinatal period. Twenty two (13%) had lesions due to factors acting in childhood. (4% could not be categorised in this way). The commonest single primary diagnoses were birth asphyxia in 19 (11%) cases and retinopathy of prematurity in 19 (11%) cases.
The TPR-MET oncogenic rearrangement is present and expressed in human gastric carcinoma and precursor lesions. The TPR-MET oncogenic rearrangement was originally observed in an in vitro transformed human osteosarcoma cell line. Recently, we detected the expression of this rearrangement at very low levels in several cell lines derived from human tumors of nonhematopoietic origin using a highly sensitive method based on polymerase chain reaction amplification of the transcript. We report here the results of analysis of TPR-MET expression in cell lines derived from human gastric tumors and 22 biopsy samples of human gastric mucosa showing cancer or precursor lesions. The rearranged RNA was expressed in all four cell lines as well as in biopsy samples from 12 of the 22 patients. Overexpression of TPR-MET RNA in superficial gastritis lesions with hyperplasia of glandular neck cells suggests the possible involvement of this oncogene at an early stage of gastric tumorigenesis. Analysis of gastric biopsy samples for RAS gene mutations showed base substitutions occurring in the codon 12 region of Ki- and Ha-RAS genes in four cases, including two precursor lesions.
Identification and mapping to chromosome 1 of a susceptibility locus for periinsulitis in non-obese diabetic mice. Insulin-dependent diabetes mellitus (IDDM) is a polygenic disease caused by autoimmune destruction of insulin-producing beta cells in the islets of Langerhans. Its onset is preceded by a long and variable period in which lymphoid cells infiltrate the pancreas but first remain outside the islets (peri-insulitis) before invading them (insulitis). Among susceptibility loci, only the major histocompatibility complex (MHC) has been clearly assigned. Genetic study of the nonobese diabetic (NOD) mouse model for insulin-dependent diabetes mellitus has revealed genetic linkage of insulitis and of early onset diabetes with two non-MHC loci mapping to chromosome 3 and 11 respectively. Here we report a close association of periinsulitis with a third non-MHC locus mapping to chromosome 1. Successive stages in the progression of diabetic disease thus appear to be controlled by distinct genes or sets of genes.
Failure of treatment with teicoplanin at 6 milligrams/kilogram/day in patients with Staphylococcus aureus intravascular infection. The Infectious Diseases Consortium of Oregon. Patients with blood cultures positive for gram-positive cocci were enrolled in a prospective randomized double-blind comparative trial of vancomycin at 15 mg/kg every 12 h versus teicoplanin at 6 mg/kg every 12 h for three doses and then 6 mg/kg every 24 h. A total of 54 patients were randomized, and 40 were evaluable. Of the 40, 9 had infection of indwelling vascular catheters. Four infections were due to Staphylococcus aureus, and five were due to Staphylococcus epidermidis. In concert with catheter removal, all patients were treated successfully, regardless of which drug they were taking. Of 31 patients without an indwelling catheter, 19 were infected with S. aureus, and 12 of the 19 had either endocarditis or mycotic aneurysm. Six of eight patients given teicoplanin failed treatment, as opposed to one of four patients given vancomycin (P = 0.14). Of greater concern, four of four patients with left-sided endocarditis or mycotic aneurysm failed to recover when given teicoplanin, as opposed to one of three patients given vancomycin (P = 0.07). Although not quite statistically significant, the unexpectedly high number of treatment failures with teicoplanin resulted in a decision to discontinue patient enrollment. It is suggested that future trials explore the efficacy of larger doses of teicoplanin.
Stroke Prevention in Atrial Fibrillation Study. Final results BACKGROUND. Atrial fibrillation in the absence of rheumatic valvular disease is associated with a fivefold to sevenfold increased risk of ischemic stroke. METHODS AND MAIN RESULTS. The Stroke Prevention in Atrial Fibrillation Study, a multicenter, randomized trial, compared 325 mg/day aspirin (double-blind) or warfarin with placebo for prevention of ischemic stroke and systemic embolism (primary events), and included 1,330 inpatients and outpatients with constant or intermittent atrial fibrillation. During a mean follow-up of 1.3 years, the rate of primary events in patients assigned to placebo was 6.3% per year and was reduced by 42% in those assigned to aspirin (3.6% per year; p = 0.02; 95% confidence interval, 9-63%). In the subgroup of warfarin-eligible patients (most less than 76 years old), warfarin dose-adjusted to prolong prothrombin time to 1.3-fold to 1.8-fold that of control reduced the risk of primary events by 67% (warfarin versus placebo, 2.3% versus 7.4% per year; p = 0.01; 95% confidence interval, 27-85%). Primary events or death were reduced 58% (p = 0.01) by warfarin and 32% (p = 0.02) by aspirin. The risk of significant bleeding was 1.5%, 1.4%, and 1.6% per year in patients assigned to warfarin, aspirin, and placebo, respectively. CONCLUSIONS. Aspirin and warfarin are both effective in reducing ischemic stroke and systemic embolism in patients with atrial fibrillation. Because warfarin-eligible patients composed a subset of all aspirin-eligible patients, the magnitude of reduction in events by warfarin versus aspirin cannot be compared. Too few events occurred in warfarin-eligible patients to directly assess the relative benefit of aspirin compared with warfarin, and the trial is continuing to address this issue. Patients with nonrheumatic atrial fibrillation who can safely take either aspirin or warfarin should receive prophylactic antithrombotic therapy to reduce the risk of stroke.
Ploidy in invasive colorectal cancer. Implications for metastatic disease. A retrospective study was performed to determine the ploidy of superficial (above muscularis propria) and deep (below muscularis propria) biopsy specimens from the primary colorectal cancer of 88 patients with Dukes Stage C2 and D colorectal tumors. The ploidy of lymph node and liver metastases was compared with that of the superficial and deep specimen from the corresponding primary tumor. Among the tumors studied, 78% exhibited nondiploid stemlines. In 19% of the tumors, the ploidy of the superficial biopsy differed from that of the deep biopsy. Among these discordant tumors, all of the deep biopsy specimens corresponded in ploidy to the liver metastases, whereas most of the superficial specimens were similar in ploidy to the lymph node metastases. Our observations suggest that measurement of a single site may not be sufficient to detect nondiploid stemlines within a tumor. They also suggest that measurement of deeper parts of invasive tumors may be more reflective of the phenotype of distant metastases than measurement of superficial specimens.
Holmium laser angioplasty after failed coronary balloon dilation: use of a new solid-state, infrared laser system. A new solid-state laser system was used in a case of saphenous vein graft occlusion untreatable by standard very low-profile balloon angioplasty. The 2100 nm infrared pulsed thulium/holmium: YAG laser successfully recanalized an obtuse marginal bypass graft without complications. The holmium laser has several advantages over excimer systems and may prove an effective adjunct or alternative to coronary balloon angioplasty.
Bone marrow: ultrasmall superparamagnetic iron oxide for MR imaging. An ultrasmall superparamagnetic iron oxide (USPIO) preparation was evaluated as a potential intravenous contrast agent for magnetic resonance (MR) imaging of bone marrow. One hour after administration of USPIO (40, 80, and 160 mumols of iron per kilogram body weight) in rats and rabbits, T1 and T2 relaxation times were, respectively, approximately 30%, 50%, and 65% lower than precontrast relaxation times. Maximum decrease in relaxation times of marrow occurred within 1-24 hours after intravenous administration; thereafter, relaxation times slowly returned to normal within 7 days. In vivo MR imaging of rabbits and rats confirmed that USPIO decreases signal intensity of red and yellow marrow. The decrease was most marked with gradient echo pulse sequences. An animal model of intramedullary tumor demonstrated the potential of USPIO to enable differentiation between tumor and normal red marrow. USPIO-enhanced MR imaging improves detection of smaller tumors and allows differentiation of tumor deposits from islands of hyperplastic or normal red marrow.
Schwannomas of the paranasal sinuses. Case report and clinicopathologic analysis. Schwann's cell tumors are common neoplasms arising from the neural sheath of autonomic, cranial, or peripheral nerves. We describe a case of destructive malignant schwannoma of the right ethmoid and sphenoid sinuses. The tumor was successfully treated by surgical excision, external radiotherapy, and radon seed implants. The patient remains symptom free 3 years after therapy ended, emphasizing the previously unrecognized benefits of radiotherapy for these types of tumors. The value of endoscopy in diagnosing and following schwannomas of the nasal and paranasal sinuses is highlighted in our review of the clinicopathologic features and radiologic findings of this tumor.
Differential regulation of thyroid hormone receptor messenger ribonucleic acid levels by thyrotropin-releasing hormone. In addition to its well known actions in stimulating TSH and PRL synthesis and secretion, TRH has been shown to decrease the concentration of thyroid hormone receptors (TRs) in GH4C1 cells as measured by nuclear thyroid hormone (T3) binding. In the present study we have investigated the effects of TRH on the levels of mRNA encoding the different forms of TR, TR beta-1, TR beta-2, and TR alpha-1 as well as that of the non-T3-binding variant, c-erbA alpha-2. GH3 cells were incubated with 100 nM TRH in the presence or absence of 1 nM T3 for 48 h, and mRNA levels were determined by Northern blot analysis. Results revealed that there is differential regulation of the individual TRs by TRH at the pretranslational level. The mRNA for the pituitary-specific form of TR, TR beta-2, was down-regulated by 60% by TRH in GH3 cells, while that of its alternative splice product, TR beta-1, was unchanged. A modest change was observed in TR alpha-1 mRNA levels, which were down-regulated by 20%; there was no change in c-erbA alpha-2 mRNA levels. Levels of nuclear T3 binding were assessed under the same conditions, and 100 nM TRH was found to decrease binding by 40% from 0.78 to 0.46 fmol/micrograms DNA. A similar change in nuclear T3 binding was seen after incubation with 1 nM T3. The effect of TRH on the GH mRNA response to T3 was investigated. In the absence of TRH there was a 4-fold induction of GH mRNA after incubation with 1 nM T3. In the presence of 100 nM TRH, no significant induction in GH mRNA by T3 was seen, indicating that T3 responsiveness as well as receptor concentration are diminished by TRH under these conditions.
Current role of catheter ablative procedures in patients with cardiac arrhythmias. A report for health professionals from the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Catheter ablative techniques have assumed an increasingly important role in the treatment of patients with drug-refractory cardiac arrhythmias. Catheter ablation of the AV junction is considered the procedure of choice for management of patients without bypass tracts with drug-resistant supraventricular arrhythmias. Catheter techniques have been used with increasing frequency in attempts to ablate accessory AV tracts. These techniques currently appear to be less effective than surgical techniques but involve less morbidity and expense. In some centers, accessory pathway ablation using catheter techniques is the procedure of first choice in selected patients with drug-refractory tachycardia mediated by an accessory pathway. Catheter ablation of ventricular tachycardia should be reserved for patients with mappable ventricular tachycardia who are not candidates for cardiac electrosurgery or insertion of an automatic defibrillator. The development of more flexible catheters and more manageable energy delivery systems holds promise for more effective catheter techniques.