shukoor65/lab-rag-model huggingface dataset:
Dopaminergic abnormalities in borderline essential hypertensive patients. To explore whether an altered metabolic pathway of dihydroxyphenylalanine (DOPA) may be related to some previously observed dopamine abnormalities in borderline hypertension, we measured basal and DOPA-induced (500 mg orally) changes in blood pressure and pulse rate as well as in three hourly plasma and urine samples. We found that borderline hypertensive patients compared with controls 1) showed a higher baseline urinary excretion of methoxytyramine, a marker of exocytotic dopamine release, with a greater DOPA-induced decrease of systolic blood pressure without reflex tachycardia; 2) had in response to DOPA a blunted plasma DOPA and free dopamine increase but an accentuated plasma dopamine sulfate and urinary DOPAC excretion; and 3) eliminated comparable quantities of dopamine in urine despite a lower rise in the glomerular DOPA load. Furthermore, although DOPA elicited natriuresis in both groups, its effect was greater in borderline hypertensive patients, who lacked the urinary sodium correlation with urinary dopamine excretion seen in control subjects. These data are compatible with increased basal exocytotic dopamine release and accelerated neuronal and renal (extraneuronal) dopamine generation from administered DOPA in borderline hypertension. The DOPA-induced hypernatriuresis exceeding augmented dopamine in borderline hypertensive patients, contrasting with the urinary sodium and dopamine correlation in control subjects, suggests that DOPA induced an additional natriuresis in borderline hypertensive patients by a decrease in renal sympathetic tone because of its central inhibition of sympathetic outflow, which also may account for the absence of reflex tachycardia.
Amantadine toxicity presenting with complex ventricular ectopy and hallucinations. Amantadine hydrochloride is a commonly prescribed drug with a narrow therapeutic-to-toxic range. Toxicity is related to the anticholinergic properties of the drug and primarily affects the cardiovascular, central nervous, and respiratory systems. We report the case of an adolescent who ingested 1.3 grams of amantadine and developed complex ventricular arrhythmias and altered mental status. The arrhythmias were completely suppressed with intravenous lidocaine. This case supports the hypothesis that lidocaine is effective for treatment of ventricular arrhythmias secondary to amantadine toxicity.
Flash lamp pumped dye laser for rosacea-associated telangiectasia and erythema. The persistence of facial telangiectasis and erythema in patients with rosacea frequently presents a major cosmetic problem. It may also contribute to relapses of papular and pustular lesions. This study of 27 patients treated for their telangiectasia and erythema with a flash lamp pumped dye laser tuned at 585 nm is described. The laser gave good or excellent reduction of telangiectasia and erythema and overall appearance in 24 of the patients with between one and three treatments. In addition, papule and pustule activity was decreased in 59.2% of the patients, with those with the most severe pre-treatment activity having the most significant improvement. It is suggested that this is a useful additional form of treatment that may improve the telangiectasia and erythematous component of rosacea.
Testing the psychogenic vomiting diagnosis. Four pediatric patients. We treated four patients with chronic vomiting during childhood in whom a tentative diagnosis of psychogenic vomiting was made after an extensive evaluation. In each case, the diagnosis was reconsidered during the course of treatment, as observations about the patients and their response to interventions accumulated. In three instances, these observations did not fit those expected if the diagnosis of psychogenic vomiting was correct. This led to a reexamination of the organic evaluation and the discovery of an undiagnosed organic contribution to the vomiting. In the fourth patient, gastric emptying studies confirmed that there was a strong psychological contribution to the vomiting, and helped to more carefully define this contribution. Family and individual psychotherapy and treatment were aided by the greater clarity in diagnosis.
Strongly succinate dehydrogenase-reactive blood vessels in muscles from patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes. Intramuscular blood vessels were examined with succinate dehydrogenase stain in skeletal muscle biopsy specimens from 6 patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). Almost all arteries had large granular deposits with high succinate dehydrogenase activity in their walls. Electron microscopic examination of serial frozen sections of these biopsies showed that the smooth muscle cells of the strongly succinate dehydrogenase-reactive blood vessels contained markedly proliferated mitochondria, characteristic of patients with MELAS. The presence of strongly succinate dehydrogenase-reactive blood vessels in muscle biopsy specimens provides an important clue toward understanding the underlying pathogenetic mechanism in patients with MELAS as well as another approach to the diagnosis of this disorder.
Study of human papillomavirus in oral epithelial dysplasia and epidermoid carcinoma in the absence of tobacco and alcohol use. Human papillomaviruses (HPVs) are implicated in the etiology of benign and malignant mucosal lesions in both human beings and animals. The oncogenic role of HPV in malignant cervical lesions is well supported by DNA hybridization techniques and epidemiologic studies. However, the role of HPV in oral epithelial dysplasia and epidermoid carcinoma remains speculative. In this study the in situ hybridization technique was used to detect HPV genotypes 6 and 11; 16 and 18; and 31, 33, and 35 in tissue specimens from a study group consisting of 18 patients who were non-tobacco users, or non-tobacco and non-alcohol users, in whom oral epithelial dysplasia and epidermoid carcinoma developed. The hybridization findings were compared with those of a comparable control group of patients with similar lesions who had a history of tobacco and alcohol use. None of the study group cases was reactive with any of the DNA probes. Two cases of the control group showed positive hybridization with HPV DNA probe types 6/11 and 16/18. The implications of these findings are presented and discussed in an attempt to clarify the role of HPV in HPV-associated oral epidermoid carcinomas.
Reversal of low dose angiotension hypertension by angiotensin receptor antagonists. During acute angiotension II (Ang II) infusion (200 ng/kg/min i.v.) into anesthetized rats, mean arterial pressure rose from 124 +/- 1 to 154 +/- 2 mm Hg. The peptidic Ang II antagonist saralasin lowered arterial pressure in a dose-dependent manner. The maximal decrease in pressure was similar to that observed after the Ang II infusion was discontinued. The nonpeptide Ang II antagonist, 4'-[( 2-butyl-4-chloro-5-(hydroxymethyl)-1H-imidazole-1-yl] methyl) [1,1'-biphenyl] -2-carboxylic acid (SC-48742), lowered acutely elevated arterial pressure to a level similar to that on discontinuation of the angiotensin infusion. Chronic (8 days) infusion of Ang II (20 ng/kg/min i.v.) increased mean arterial pressure from 116 +/- 3 to 164 +/- 7 mm Hg, which then decreased to 121 +/- 6 mm Hg on termination of the infusion. Saralasin (10 micrograms/kg/min, a maximally effective dose during acute angiotensin infusion) decreased mean arterial pressure from 168 +/- 7 to 141 +/- 3 mm Hg, a pressure significantly higher (p less than 0.05) than the pressure observed after the angiotensin infusion was discontinued. SC-48742 decreased mean arterial pressure from 167 +/- 7 to 127 +/- 3 mm Hg, a pressure not statistically different from the minimum pressure observed after the angiotensin infusion was terminated. The mechanism of blood pressure elevation during acute high dose or chronic low dose Ang II infusion is different, the latter having a significant neural component as measured by the response to trimethaphan. The peptidic antagonist saralasin was fully effective in lowering acute angiotensin hypertension but only partially effective during chronic hypertension.
Radiologic evaluation of esophageal motility: results in 170 patients with chest pain. The role of radiologic evaluation of esophageal motility in patients with chest pain has been studied rarely. Consequently, we compared the results of radiologic and manometric examinations of the esophagus in 170 patients (106 women, 64 men; mean age, 53 years) with chest pain. Manometry, used as the standard, was normal in 114 (67%) patients, and showed the following abnormal diagnoses in the remaining 56 (33%): nonspecific esophageal motility disorder in 27 (48%), nutcracker esophagus in 16 (29%), diffuse esophageal spasm in 11 (20%), and achalasia in two (4%). Radiologic specificity was 93% (106/114) and overall sensitivity only 36% (20/56). Sensitivity increased to 50% by excluding those with nutcracker esophagus, a purely manometric diagnosis. Of the 20 patients in whom nonspecific esophageal motility disorder and diffuse esophageal spasm were undetected on radiologic examination, minimal manometric criteria for diagnosis were available in 18. Our results show that radiologic recognition of normal esophageal peristalsis is excellent. However, the vast majority of patients with chest pain do not appear to have abnormal esophageal motility on radiologic evaluation.
Junctional tachycardias: anatomic substrate and its significance in ablative procedures. The conduction system was studied by serial section in three patients with intractable supraventricular tachycardias originating from the atrioventricular (AV) junction who died suddenly. The three patients were a 6 month old girl (Case 1), a 5 month old boy (Case 2) and a 22 year old woman (Case 3). The latter had a pacemaker inserted after surgical ablation of the AV node. The heart was hypertrophied and enlarged in all. In Case 1, the AV node was partly within the central fibrous body and there was a left-sided AV bundle with acute necrosis in the summit of the ventricular septum, adjacent to the AV node and bundle. In Case 2, the coronary sinus was displaced cranially close to the central fibrous body, resulting in abnormality of the latter, with entrapment, distortion and division of the AV node and bundle into two distinct components within the central fibrous body. In Case 3, a left-sided AV node was connected to the atrial septum. The right AV node was completely interrupted by sutures and the penetrating and branching bundle and bundle branches were markedly fibrosed. In addition, the atrial septum and summit of the ventricular septum showed marked inflammatory reaction with fibrosis, which was more marked on the right ventricular side. Histologic examination of the conduction system in all three cases demonstrated congenital abnormalities of the AV junction that may be related to the tachycardia. These findings emphasize the need to carefully evaluate the atrial septum and AV junctional area, including the coronary sinus, before ablative procedures are undertaken.
The Carney complex with ocular signs suggestive of cardiac myxoma. We treated a patient who had ophthalmic findings of the Carney complex that led to a search for and the discovery of asymptomatic cardiac myxoma. Substantial morbidity and mortality are associated with the complex because of the occurrence of cardiac myxoma. Facial and eyelid lentigines, conjunctival and caruncle pigmentation and eyelid pigmentation may precede signs or symptoms of cardiac myxoma. A study of the patient's primary relatives disclosed manifestations of the complex transmitted in a manner consistent with mendelian autosomal dominant inheritance.
Tuberculosis cutis miliaris disseminata as a manifestation of miliary tuberculosis: literature review and report of a case of recurrent skin lesions. The development of severe adverse reactions to antituberculous drugs in a patient with miliary tuberculosis led to unorthodox, suboptimal antituberculous therapy. The patient's failure to respond to therapy was discovered when acid-fast bacilli were detected in new skin lesions. Such lesions have been described in the literature as tuberculosis cutis miliaris disseminata; 24 cases (in addition to that described herein) have been reported thus far. The patient eventually recovered completely after detection and drainage of a large retrofascial tuberculous abscess. This case illustrates the importance of careful examination of the skin in clinical medicine, as tuberculosis cutis miliaris disseminata is an easily overlooked sign of miliary tuberculosis.
Importance of ulceration of carotid plaque in determining symptoms of cerebral ischemia. In order to investigate the relationship between carotid plaque morphology and symptoms of cerebral ischemia, a prospective clinicopathological study was performed. Ninety consecutive intact carotid plaques obtained from surgery and 43 carotid plaques from cadavers without symptoms of cerebral ischemia were evaluated. Ulceration and mural thrombus were the only morphologic findings statistically correlated to the presence of hemispheric symptoms (p less than 0.02). Intramural hemorrhage was more common in patients with hemispheric symptoms but this difference was not statistically significant (p = 0.31). Plaque causing high degree stenosis had a higher incidence of intramural hemorrhage (p = 0.04) and ulceration (p less than 0.02). Ulceration of plaque plays a major role in the onset of hemispheric symptoms. The results of our study support the hypothesis that in the majority of the cases, hemispheric symptoms are embolic in nature.
Early experience with the smart laser in the treatment of atherosclerotic occlusions. A dual-laser system (helium-cadmium and pulsed dye) capable of continuous computer analysis of spectroscopic characteristics of tissue fluorescence, which can distinguish atherosclerotic plaque from components of normal arterial wall, was used to deliver laser energy to ablate plaque. During a 1-year period this system was used to facilitate balloon angioplasty of short (3 to 17 cm) total occlusions of the superficial femoral or popliteal arteries only when standard angioplasty techniques were ineffective. During the year of the study, in one institution 415 patients were subjected to arteriography of the lower extremities for leg ischemia (397 for limb salvage indications). Standard angioplasty techniques were used in 94 of these patients; 218 patients were unsuitable for standard angioplasty, did not fulfill criteria for "smart" laser treatment, and underwent standard bypass operations. Only 11 patients (plus six others in the second institution) requiring treatment fulfilled the criteria for use of the "smart" laser. In 10 patients the occluding lesion was traversed by the laser wire (diameter 0.021 inch), and luminal patency was effectively restored by balloon angioplasty to greater than or equal to 70% of the most normal-appearing segment of that artery. Satisfactory luminal patency has persisted for 2 to 12 months (mean 6 months) in nine patients; the lesion in the tenth patient restenosed at 3 months. The laser procedure was unsuccessful in all three patients with occlusions greater than 10 cm and in four others. Although there were three microperforations with the laser wire, there were no clinically significant complications.
The cubital tunnel and ulnar neuropathy. The anatomy of the cubital tunnel and its relationship to ulnar nerve compression is not well documented. In 27 cadaver elbows the proximal edge of the roof of the cubital tunnel was formed by a fibrous band that we call the cubital tunnel retinaculum (CTR). The band is about 4 mm wide, extending from the medial epicondyle to the olecranon, and perpendicular to the flexor carpi ulnaris aponeurosis. Variations in the CTR were classified into four types. In type 0 (n = 1) the CTR was absent. In type Ia (n = 17), the retinaculum was lax in extension and taut in full flexion. In type Ib (n = 6) it was tight in positions short of full flexion (90 degrees to 120 degrees). In type II (n = 3) it was replaced by a muscle, the anconeus epitrochlearis. The CTR appears to be a remnant of the anconeus epitrochlearis muscle and its function is to hold the ulnar nerve in position. Variations in the anatomy of the CTR may explain certain types of ulnar neuropathy. Its absence (type 0 CTR) permits ulnar nerve displacement. Type Ia is normal and does not cause ulnar neuropathy. Type Ib can cause dynamic nerve compression with elbow flexion. Type II may be associated with static compression due to the bulk of the anconeus epitrochlearis muscle.
Prediction of neurodevelopmental outcome in infants with and without bronchopulmonary dysplasia. In a group of 236 very low birth weight (VLBW) surviving infants, 60 had developed bronchopulmonary dysplasia (BPD) in the nursery. When compared with the 176 infants without BPD, infants with BPD were smaller, more immature, with lower one- and five-minute Apgar scores. Infants with BPD had a greater incidence of cardio-pulmonary and central nervous system (CNS) complications in the nursery. On follow-up, 25 (42%) of these infants were abnormal developmentally compared to 7% of infants without BPD (p less than .001). When comparisons were made within the group of infants with BPD, very few differences were found in maternal or infant risk factors between the normal and abnormal infants. The infants with BPD who had poor outcome more often had seizures and severe intraventricular hemorrhage (IVH). The infants with BPD who had good outcome were more often small for gestational age (SGA) and resuscitated with intubation at birth. They had apnea in the nursery more frequently than did abnormal infants with BPD. We conclude that VLBW infants with BPD are at greater risk for poor neurodevelopmental outcome than those without BPD. The risk for the infant with BPD relates to CNS complications rather than to chronic lung disease.
Postoperative pulmonary edema in young, athletic adults. Pulmonary edema secondary to postextubation laryngospasm is a potentially life-threatening problem, demanding early diagnosis and prompt treatment. We believe that this problem has been grossly underestimated in its incidence, as only seven adults have been reported in the English literature, whereas seven adults have been observed at our institution in only a 24 month period. All were young, healthy, athletic adult males (average weight, 218 pounds) who underwent relatively minor, uncomplicated surgical procedures under general anesthesia. Five of these patients were collegiate and/or professional athletes and had meticulous medical records detailing their clinical course. Clinical laryngospasm was noted immediately following extubation and anesthesia by mask with subsequent pulmonary edema. The diagnoses were confirmed by clinical examination, arterial blood gas determinations or pulse oximetry, and chest roentgenogram. Four adults required reintubation. Six of the seven adults demonstrated very rapid resolution of the pulmonary edema with prompt diagnosis and institution of a therapeutic regimen including oxygen, diuretics, reintubation, and/or positive pressure ventilation. In one patient, the problem was not immediately recognized, and progressed to florid pulmonary edema requiring emergent intubation 14 hours later in the emergency room, and 3 days of mechanical ventilation. The etiology of pulmonary edema following upper airway obstruction represents an interplay between several factors: cardiogenic and neurogenic mechanisms, as well as hypoxia contribute. In this group, excessive negative intrathoracic pressure generated by forced inspiration against a closed glottis is the most likely, consistent, and logical explanation. This study suggests that young, healthy, athletic males may be at increased risk for this complication.
Mammographic densities and risk of breast cancer. To determine the relation of mammographic densities to subsequent breast cancer risk, a case-control study was undertaken using prediagnostic mammograms of screening program participants. Mammograms of cases (n = 266) and controls (n = 301) were blindly assessed for mammographic densities, which were measured by planimetry. The odds of breast cancer increased steadily with increasing breast density (test for trend, P less than 0.0001). Breast cancer odds was 1.7 for densities between 5% and 24.9%, 2.5 for 25% through 44.9%, 3.8 for 45% through 64%, and 4.3 for densities of 65% and greater (referent = less than 5% densities). Odds ratios also increased with increasing densities among women with the P2 and DY mammographic patterns. These findings suggest that the percentage of mammographic densities in the breast can predict breast cancer risk more accurately than a qualitative assessment of mammographic patterns.
Major vascular complications of orthognathic surgery: false aneurysms and arteriovenous fistulas following orthognathic surgery. False aneurysms and arteriovenous fistulas are rare complications of orthognathic surgery. The vessel most commonly involved with false aneurysms following mandibular surgery is the internal maxillary artery, and this vessel, especially the sphenopalatine branch, may also be involved following maxillary surgery. An unusual factor in the presentation of false aneurysms following Le Fort I osteotomies is an initial episode of epistaxis occurring greater than 2 weeks postoperatively. Arteriovenous fistulas following orthognathic surgery are more apt to involve large vessels, especially the internal carotid artery. Embolization procedures are the treatment of choice for false aneurysms and arteriovenous fistulas in the maxillofacial region following orthognathic surgery.
Pharmacokinetics of low-molecular-weight heparin and unfractionated heparin during elective aortobifemoral bypass grafting. Perioperative monitoring has demonstrated that administration of heparin on an empirical basis is associated with a wide variation in patient response and elimination rate. This problem may be overcome by intervention on the basis of perioperative monitoring or by using forms of heparin with different pharmacokinetic properties. When compared with unfractionated heparin, low-molecular-weight heparin has a higher bioavailability after subcutaneous administration, a linear clearance mechanism with a prolonged half-life, and is at least as effective in preventing postoperative vein thrombosis. Theoretically these characteristics of low-molecular-weight heparin could lead to more predictable levels of heparin activity. In this study we compared the pharmacokinetics of low-molecular-weight heparin and unfractionated heparin after an intravenous injection in patients undergoing aortic graft surgery. Heparin activity was measured before heparin administration and at 5, 20, 35, 50, 65, 80, 95, and 110 minutes after administration. The anti-Xa activity in the low-molecular-weight heparin group showed less variation and was more sustained when compared to the unfractionated heparin group. Fibrin degradation products were moderately correlated with the anti-factor Xa levels of the low-molecular-weight heparin group, but no correlation was found in the unfractionated heparin group. The anti-factor Xa activity of low-molecular-weight heparin was, in contrast to that of unfractionated heparin, not completely reversible by protamine administration. The blood loss was comparable in both groups. In contrast to what was expected, the pharmacokinetic profiles of low-molecular-weight heparin and unfractionated heparin showed a similarity after intravenous injection in patients undergoing aortobifemoral bypass grafting. Factors that could have influenced the pharmacokinetic behavior of heparin are discussed.