shukoor65/lab-rag-model huggingface dataset:
Use of oligonucleotide probes directed against T cell antigen receptor gamma delta variable-(diversity)-joining junctional sequences as a general method for detecting minimal residual disease in acute lymphoblastic leukemias. To provide a sensitive and generally applicable method to detect clonal cells in acute lymphoblastic leukemias (ALL), we have designed a new strategy based on the polymerase chain reaction (PCR) amplification of the T cell receptor gamma delta gene rearrangements found in most T and B lineage ALLs. PCR allows rapid sequencing of variable-(diversity)-joining (V-[D]-J) junctions from tumor DNA and construction of anti-junctional oligonucleotides (AJOs) used as probes to detect clonal cells in the same patient. We have defined oligonucleotides suitable for all T cell receptor (TCR) rearrangements involving functional V gamma segments. Oligonucleotides corresponding to preferential TCR delta rearrangements in T and B lineage ALLs were also used. By analysis of the nucleotide sequence of 52 V gamma-V gamma junctions from 30 cases of B and T ALLs, we demonstrate that V-J junctional sequences are clone specific in both lineages and at all stages of differentiation examined despite the frequent presence of the recently described P nucleotides. Experiments performed with TCR gamma delta AJOs on DNA from tumor cells and polyclonal T cells show that AJOs can be used to differentiate clonal cells from polyclonal T cells, distinguish between different T cell clones, and detect residual clonal populations at 10(-4)/10(-5) dilution. AJOs were also used to detect residual disease in samples from patients in clinical and morphological complete remission. Finally, rearrangement patterns were studied by classical Southern analysis in selected cases at both presentation and subsequent relapse showing absence of clonal evolution in most cases. V-(D)-J nucleotide sequences of rearrangements with an identical pattern of rearrangement at presentation and relapse were identical in all cases analyzed. We therefore describe a new, specific, and clinically useful strategy for the detection of minor clonal populations applicable in the majority of cases of ALL.
Hypertension in young patients. Hypertension is often unrecognized in infants and children. Primary care physicians need the equipment necessary to measure blood pressure in young patients and tables or graphs showing normal values for age and sex. Children should have a blood pressure measurement and preventive counseling at each yearly checkup. Significant hypertension should never be dismissed as a temporary problem but rather should be carefully investigated, treated, and followed up.
Tuberculous pericarditis. Tuberculosis is responsible for approximately 4% of cases of acute pericarditis, 7% of cases of cardiac tamponade, and, in older studies, 6% of instances of constrictive pericarditis. However, in some nonindustrialized countries, tuberculosis is a leading cause of pericarditis. The diagnosis is based on demonstration of tubercle bacilli in pericardial fluid or on histologic section of the pericardium, or proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis. Treatment consists of triple drug therapy for at least 9 months (isoniazid, rifampin, and streptomycin or ethambutol). Pyrazinamide can be used for the first 2 months, and the total therapeutic period can then be shortened to 6 months after culture conversion. Three months of corticosteroid therapy may be useful in patients in whom pericardial effusion persists or recurs despite the use of antituberculous drugs. Surgical resection of the pericardium is indicated for recurrent or life-threatening tamponade, or when there is persistent elevation of systemic venous pressure unrelieved by pericardiocentesis. As many as one third to one half of patients will eventually require pericardiectomy despite adequate drug therapy.
Sequential high-dose methotrexate and fluorouracil combined with doxorubicin--a step ahead in the treatment of advanced gastric cancer: a trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. In a prospective phase III multicenter trial, 213 patients with advanced measurable or nonmeasurable gastric cancer were randomized to receive methotrexate (MTX), fluorouracil (5-FU), and Adriamycin (doxorubicin; Farmitalia Carlo Erba, Milan, Italy) (FAMTX) or 5-FU, Adriamycin, and mitomycin (FAM). The results show a significantly superior response rate (41% v 9% [P less than .0001]), and survival (median, 42 weeks v 29 weeks [P = .004]) for FAMTX. There was a cumulative thrombocytopenia in FAM and not in FAMTX. The FAMTX protocol should be the reference treatment in future clinical trials that seek to improve the therapeutic outcome in advanced gastric cancer.
Genitourinary rhabdomyosarcoma in children. The survival rates for childhood rhabdomyosarcomas have risen from 20% to 50% with the institution of a multidisciplinary approach involving the pediatric oncologist, radiation therapist, and surgeon. Increased survival has been particularly striking in the case of genitourinary rhabdomyosarcomas, which have a more favorable prognosis than rhabdomyosarcomas occurring in other anatomic sites. By stratifying genitourinary rhabdomyosarcomas by anatomic subgroup, i.e., paratesticular, bladder or bladder-prostate, and gynecologic, insight into specific predictors of failure can be obtained. Patients judged to be high risk at diagnosis can then be selected for more intensive or novel forms of therapy.
Increment-threshold spectral sensitivity in blindsight. Evidence for colour opponency. In the circumscribed visual field defects of 3 patients, increment-threshold spectral sensitivity was measured with a guessing paradigm. Nine 116', 200 ms narrowband stimuli with maximum transmission between 450 and 660 nm were presented on a white background of photopic or scotopic luminance. Sensitivity measured in the blind field was compared with that at matched positions in the patients' normal hemifield, and with that at corresponding positions in 2 control subjects. Results show that spectral sensitivity in the blind field, albeit reduced by up to 1 log unit, shows normal dependence on adaptation level, reflecting rod activity under scotopic, and cone activity under photopic conditions. Characteristic discontinuities in the spectral sensitivity curve seen under light adaptation are evidence for colour-opponent processes, presumably involving primate beta retinal ganglion cells.
Effect of lung hyperinflation and endotracheal suctioning on heart rate and rhythm in patients after coronary artery bypass graft surgery. We examined the effect of lung hyperinflation and suction on PaO2, heart rate, and rhythm in patients after coronary artery bypass graft surgery (N = 26). Three lung hyperinflation breaths, at one of five randomly ordered volumes (tidal volume, 12 cc/kg, 14 cc/kg, 16 cc/kg, or 18 cc/kg of lean body weight) were delivered, by a ventilator (fraction of inspired oxygen 1.0), followed by 10 seconds of continuous suction. Lung hyperinflation and suctioning were repeated three times. Repeated-measures analysis of variance revealed a statistically significant increase (p = 0.000) in PaO2 immediately after the third suction pass, which was volume dependent (p = 0.009). A statistically significant (p less than 0.001) increase in heart rate from baseline occurred over the three lung hyperinflation-suctioning sequences that was not volume dependent. The mean increase in heart rate was 6.8 beats/min. The majority of rhythm changes for lung hyperinflation and suctioning were from normal sinus rhythm to sinus tachycardia. Suction was associated with a greater incidence of rhythm (53.9%) and arrhythmia (80.8%) changes. The most frequent arrhythmia was premature atrial contraction.
Pathogenesis of nephrolithiasis post-partial ileal bypass surgery: case-control study. The POSCH Group. Between 1975 and 1983, 838 patients were randomized into the Program on the Surgical Control of Hyperlipidemias (POSCH) trial: 417 to standard medical care and 421 to partial ileal bypass (PIB) surgery. During the course of the trial, an increased incidence of kidney stone formation was found in the surgery group (4%/year) as compared to the control group (0.4%/year). A matched triplet case-control study was conducted to assess the possible causes for the increased incidence of kidney stones. Three groups were studied: PIB stone-formers (S); PIB non-stone formers (N); and non-PIB, non-stone formers in the control group (C). Initially, 162 patients (54 triplets) were selected. Ten percent of the patients declined to participate which resulted in a sample size of 146 patients. The PIB patients had statistically significant (P less than 0.05) lower levels of serum vitamin D metabolites; lower urine volume, pH, citrate, magnesium, carbon dioxide, and sulfate, and higher urinary oxalate, ammonia and relative supersaturation for calcium oxalate and uric acid than the control patients. Although S and N had similar results, those S with no prior history of stones had a higher calcium oxalate supersaturation than similar N with a negative prior history of stones (P less than 0.025). Based on these results, all PIB patients appear to be at risk for kidney stone formation. The combination of reduced urinary volume and calcium oxalate precipitation inhibitor substance with increased calcium oxalate relative supersaturation produced an increase in nephrolithiasis risk in the PIB groups.
Catabolic illness. Strategies for enhancing recovery. After injury, infection, extensive chemotherapy, and other critical illnesses, both protein and fat are lost from the body. Although minor alterations in body composition are probably of little clinical importance, losses of body protein of 10 percent or more contribute to morbidity and debility. This catabolic response can be modified and recovery can be accelerated by a variety of approaches. First, the inflammatory response can be reduced; second, specific nutrients can be provided to support the patient's tissue requirements during catabolic illness; and third, growth factors can be used to enhance protein synthesis and tissue repair. These approaches, whether used alone or in combination, will reduce the loss of body protein, which should accelerate recovery, shorten the length of hospitalization, and reduce convalescence.
Nonarteritic anterior ischemic optic neuropathy and intraocular pressure. Several reports have suggested that nonarteritic anterior ischemic optic neuropathy (AION) may be related to increased intraocular pressure. We reviewed the records of 45 patients aged 48 through 86 years with nonarteritic AION (10 patients had bilateral AION) for intraocular pressure measurements and the diagnosis of glaucoma or suspected glaucoma. This group was compared with 45 age- and sex-matched patients with normal eye examination results. The mean +/- SD intraocular pressures were 16.3 +/- 3.3 mm Hg for 45 eyes of the 45 patients with AION and 16.1 +/- 2.8 mm Hg for 45 eyes of the 45 control patients (paired t test, P = .70). Among patients with unilateral AION, intraocular pressure was not greater in the involved eye than in the uninvolved eye. Three patients with AION had a previous diagnosis of glaucoma, while three of the control patients were being followed up with suspected glaucoma. We found no evidence in our series to support the hypothesis that AION is associated with increased intraocular pressure.
Application and results of the AO internal fixation system in nontraumatic indications. The AO internal skeletal fixation system (ISFS) permits posterior spine fixation to be restricted to the vertebrae immediately adjacent to the lesion and allows manipulation of each instrumented vertebra in three planes. In a prospective study to assess the value of this fixation for adult spinal disorders, 68 patients were reviewed. The device was used in spondylolisthesis, postlaminectomy instability, post-traumatic kyphosis, degenerative scoliosis, spinal stenosis, tumors, and infections. A total of 322 transpedicular screws have been inserted without neurologic complication. Satisfactory results were achieved in 88% of the patients, and only four pseudarthroses (6%) occurred. The ISFS provides rigid stabilization to enhance bone graft consolidation and to allow rapid postoperative mobilization in a light external orthosis.
Anomalous papillary muscle producing dynamic left ventricular outflow tract obstruction. A patient with a dynamic left ventricular outflow murmur was shown to have an anomalous anterolateral papillary muscle by transthoracic and transesophageal two-dimensional Doppler echocardiography. High late systolic outflow velocity and systolic anterior motion were demonstrated in the lateral outflow tract near the anomalous muscle, suggesting a role for the Venturi effect. This is the first confirmation by Doppler echocardiography of an anomalous papillary muscle contributing to abnormal left ventricular hemodynamics.
Complex partial status epilepticus of extratemporal origin: report of a case. A 28-year-old woman with no history of seizure was 7 months pregnant when she developed a prolonged complex partial status epilepticus (CPSE) organized in recurrent complex partial seizures of occipital origin, which was ascertained by the presence of elementary visual hallucinations and nystagmus heralding the attacks. EEG demonstrated recurrent seizures starting from the right occipital area. This especially refractory case of CPSE resolved after treatment with antiepileptic drugs and termination of pregnancy by cesarean section.
Cranial nerve involvement and base of the skull erosion in nasopharyngeal carcinoma. In a prospective study of 262 consecutive patients with nasopharyngeal carcinoma (NPC), using computed tomography (CT) as their baseline evaluation, erosion of the base of the skull and intracranial extension into the middle cranial fossa were found in 31.3% and 12.2% of patients, respectively. Thirty-four of these patients had cranial nerve involvement at presentation; 30 of them had involvement of one or more of the third to sixth cranial nerves. Most cases of intracranial extension of tumor were accompanied by erosion of the base of the skull, but the reverse was not true. All patients with cranial nerve palsy involving the third to sixth cranial nerves had associated erosion of the ipsilateral base of the skull. The CT evaluation of patients with cranial nerve involvement who are believed to harbor NPC should include thin cuts of the base of the skull for detection of subtle bone erosion. This may be the only clue to the presence of a small NPC. The prognostic significance of cranial nerve involvement, base of the skull erosion, and intracranial extension of the tumor on the survival of the group of 84 patients who had T4 tumors was evaluated with regression analysis using the Cox model. Only cranial nerve involvement was found to be a significant factor influencing survival.
Comparison of the generation of albumin-associated cytotoxic activity in supernatants from ethanol-containing cultures of human blood monocyte-derived macrophages and of two human hepatoma cell lines. The rates of oxidation of ethanol to acetate by human blood monocyte-derived macrophages and the two human hepatoma cell lines PLC/PRF/5 and Hep G2 were studied. The average rates obtained were, respectively, 621, 447 and 596 nmol/h/mg cellular protein. Cultures of these three cell types, containing known quantities of cellular protein per flask, were incubated with 0 or 2 mg ethanol/ml for 72 h and the culture supernatants subjected to affinity chromatography on blue sepharose CL-6B. Pure albumin fractions obtained in this way were adjusted to the same optical density and tested for cytotoxicity against A9 cells. The data showed that the albumin fractions obtained from ethanol-containing macrophage cultures were considerably more cytotoxic than those obtained from ethanol-containing cultures of PLC/PRF/5 and Hep G2 cells. It appeared that, for a given quantity of ethanol metabolised, considerably more acetaldehyde was released extracellularly by macrophages than by the two hepatoma cell lines and that this acetaldehyde bound to albumin to form cytotoxic acetaldehyde-albumin complexes. The data raise the possibility that macrophages are an important source of extracellular acetaldehyde and circulating acetaldehyde-albumin complexes in vivo.
The endocrine effects of long-term treatment with mifepristone (RU 486). Mifepristone (RU 486) is a compound with progesterone as well as cortisol-blocking activities. We investigated the endocrine effects of long-term therapy of 10 patients with meningiomas with 200 mg mifepristone daily for 1 yr. Most patients initially complained of nausea, vomiting, and/or tiredness. In four patients prednisone (7.5 mg/day) had to be given simultaneously in order to overcome these side-effects. In retrospect those patients who presented with the most severe side-effects showed the most rapidly occurring activation of the hypothalamo-pituitary-adrenal-axis, as measured by an increase of circulating cortisol levels as well as of urinary cortisol excretion. Therapy with RU 486 activated the hypothalamo-pituitary-adrenal axis, resulting in a resetting of this system at a higher level at which the diurnal rhythm and the responsiveness to CRH stimulation were maintained, whereas the sensitivity to dexamethasone had diminished. Secondarily the production of androstenedione and estradiol increased considerably. These endocrine changes were caused by the induction of partial cortisol receptor resistance during therapy with RU 486. The compensatory overproduction of androgens and consequently of estrogens during long-term RU 486 therapy might limit its use as a single treatment in the treatment of estrogen-dependent cancer.
Varicella zoster virus DNA in throat swabs. Eighty-one throat swabs from 18 patients infected with varicella were tested for varicella zoster virus DNA by the polymerase chain reaction. The positive rates were 26.2% (11/42) during the incubation period and 89.7% (35/39) after clinical onset. The results indicate the pharynx is a site for early replication of the virus.
Content and boundaries of medicine in long-term care: physicians talk about stroke. Twenty physicians were interviewed about roles, treatments, goals, and relationships with older patients, especially stroke patients. Findings from this descriptive, anthropological investigation address the problem of congruence between needs and existing services, and in doing so, recast the ongoing debate about the medicalization of long-term care. This study emphasized the nonmedical features of geriatric medicine in general and stroke care in particular. In many instances, these physicians attempt to bridge gaps between medical and emotional needs and clinical and social services with social and psychotherapeutic as well as biomedical interventions. Because we found physicians' activities with stroke patients to be so broadly construed, treatment and management of stroke may be seen as paradigmatic for the role of physicians in long-term care.
The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Knowledge of the recurrence risk following a first unprovoked seizure and the predictors of that risk are necessary for rational treatment decisions. Published estimates of recurrence risk range from 23% to 71%. In a meta-analysis of 16 reports, three methodologic factors explained much of the reported variation: (1) study inclusion criteria, ie, whether patients were enrolled at the time of their first seizure or if patients with prior seizures were included; (2) retrospective versus prospective ascertainment of patients; (3) the interval between the first seizure and the time at which risk was assessed. The average recurrence risk across the 16 studies was 51%. The risk was 40% and 52% in prospective and retrospective studies that employed first-seizure methods and 67% in non-first seizure studies. At or near 2 years following the first seizure, the recurrence risk was 36% and 47% in prospective and retrospective first-seizure studies. The distribution of prognostic factors was also important. Seizure etiology and the EEG were the strongest predictors of recurrence distinguishing between patient subgroups, with recurrence risks as low as 24% and as high as 65%. Partial seizures were associated with an increased recurrence risk, but not consistently. There is considerable agreement among studies concerning the recurrence risk following a first seizure, and much of the discrepancies among studies can be explained by differences in study methods and distributions of important prognostic factors.
Pathological features of Crohn's disease determining perforation. Even if Crohn's disease (CD) stenoses are related to perforating complications, such as abscess or fistula, it remains unclear why only some stenoses lead to such complications. We have studied the surgical specimens in 94 cases of CD to characterize the anatomical features of stenosis. We found no differences between group A (patients with perforation) and group B (noncomplicated patients) as far as extent of lesion, number of stenoses, and the caliber of the stenotic bowel. In CD of the ileum, the wall thickness of the stenoses was significantly different: 12.0 +/- 3.4 mm in group A and 7.6 +/- 3.1 mm in group B (p less than 0.001). In colonic CD, the length of stenosis was significantly greater in patients with perforation. Duration of symptoms, age at surgery, and sex did not correlate with the increased thickness or with perforating complications. These observations suggest that the fibrotic gastrointestinal tract, poorly distensible, may increase the intraluminal pressure above the stenosis and in this way squeeze bowel content through mucosal fissures of the inflamed bowel. Evaluation and monitoring of wall thickness may help in prompting surgery before the disease is complicated by perforation.
Prevalence and prognostic significance of silent and symptomatic ischemia after coronary bypass surgery: a report from the Coronary Artery Surgery Study (CASS) randomized population. The prevalence and prognostic significance of postoperative myocardial ischemia, as detected by exercise testing, were prospectively assessed in 174 patients from the Coronary Artery Surgery Study (CASS) randomized surgical population who had exercise testing before and 6 months after coronary artery bypass graft surgery. Whereas the prevalence of symptomatic ischemia significantly decreased postoperatively (52% vs. 6%, p less than 0.001), the frequency of silent myocardial ischemia did not change (30% vs. 29%). Survival at 12 years after bypass surgery based on the 6-month postoperative exercise test results was significantly better for the 112 patients with no ischemia (80%) than for the 51 patients with silent ischemia (68%) or the 11 patients with symptomatic ischemia (45%). These data show that coronary artery bypass graft surgery diminishes the overall prevalence of symptomatic but not silent ischemia and that both silent and symptomatic ischemia adversely affect the postoperative prognosis of these patients.
Subrenal capsule assay using nude mice as a predictor of the response of the gastric cancer to chemotherapy. Feasibility of utilizing human gastric cancers as first transplant generation xenografts in nude mice for determining tumor sensitivity to chemotherapeutic agents was demonstrated by applying subrenal capsule (SRC) assay. A total of 55 human gastric tumors from patients were tested in this assay. Mitomycin-C (MMC) and hexycarbamyl-5-FU (HCFU, 5-FU derivative) were selected for the treatment of these patients after surgery and also for this assay as first transplant. Evaluable rate of MMC in this assay was 92.7% and that of HCFU was 90.9%. Sensitivity of tumors to MMC was 25% and to HCFU was 32%. Correlation between response to chemotherapy of human tumors in patients and in nude mice was 78.6%. These results indicate that this assay could predict effective drugs for patients with gastric cancer.