shukoor65/lab-rag-model huggingface dataset:
Immunohistochemical analysis of plasminogen activator expression in human colorectal carcinomas: correlation with CEA distribution and tumor cell kinetics. Fifty cases of colorectal adenocarcinoma were immunohistochemically examined for the relationship between distribution of plasminogen activators (PAs) and the degree of differentiation of cancer cells as reflected by carcinoembryonic antigen (CEA) expression as well as tumor cell kinetics. The A chain of urokinase-type PA (u-PA-A) was mainly observed in the apical portions of highly differentiated cancer cells. Increased expression and change in localization to the cytoplasm were found with progressive dedifferentiation. The numbers of DNA polymerase alpha (pol. alpha) positive cancer cells also increased in line with u-PA-A expression. The B chain of u-PA (u-PA-B), and the A and B chains of tissue-type PA (t-PA-A and -B) did not show similar alteration. The present findings suggest that the distribution of u-PA-A in colorectal carcinoma tissues, the degree of tumor differentiation, and the proliferation kinetics of cancer cells are closely related.
Increased incidence of solid malignant tumors after bone marrow transplantation for severe aplastic anemia. From May 1980 to December 1989, 107 consecutive patients with non-constitutional severe aplastic anemia underwent bone marrow transplantation at our institution using cyclophosphamide and thoraco-abdominal irradiation as conditioning regimen. During the same period, 40 patients with Fanconi anemia were also grafted after a similar conditioning, giving a total series of 147 patients. With a mean follow-up of 64 months, four male patients developed a solid malignant tumor, a number that leads to an 8-year cumulative incidence rate of 22% (eg, relative risk to general population = 41, P less than .001). These results should be considered as a warning to clinicians who follow these successfully grafted long-term patients.
Intraventricular blood flow during isovolumetric relaxation and diastole in hypertrophic cardiomyopathy. Forty patients with hypertrophic cardiomyopathy were investigated by Doppler echocardiography for intraventricular blood flow abnormalities. None had a bundle branch block. The patients were recruited on the basis of the presence of at least one of four different types of abnormal left ventricular blood flow movements during systole, isovolumetric relaxation, and diastole (time after mitral valve opening). The abnormal blood flow patterns were composed of the following: (1) systolic left ventricular outflow and midventricular obstruction in 20 of 40 and in 6 of 40 patients, respectively; (2) retrograde isovolumetric relaxation flow (IVRFretro; mean velocity, 0.7 +/- 0.3 m/sec), that is, flow toward the apex of the left ventricle, in 28 of 40 patients; (3) antegrade isovolumetric relaxation flow (IVRFante; mean velocity, 1.6 +/- 1.0 m/sec), that is, flow toward the left ventricular outflow tract, in 3 of 40 patients; and (4) diastolic antegrade flow (DFante; mean velocity, 0.9 +/- 0.3 m/sec), that is, flow opposite to mitral inflow, in 10 of 40 patients. There were significantly fewer patients with asymmetric septal hypertrophy (group 1) than with apical hypertrophic cardiomyopathy (group 2) showing DFante (1/29 versus 9/11, p less than 0.01). IVRFretro and DFante revealed higher velocities in patients with marked left ventricular asymmetric hypertrophy than in those with mild hypertrophy. Thus, in hypertrophic cardiomyopathy and especially in patients with marked asymmetric hypertrophy, there are different types of abnormal intraventricular blood flow movements during isovolumetric relaxation and disatole. This phenomenon is probably caused by asynchronous relaxation of the asymmetrically distributed, hypertrophied myocardium. DFante is more often observed in the apical cardiomyopathy than other forms of hypertrophic cardiomyopathy probably attributable to apically localized left ventricular cavity obliteration.
Polycystic ovarian syndrome: safety and effectiveness of stepwise and low-dose administration of purified follicle-stimulating hormone. OBJECTIVE: An attempt to induce ovulation with a single dominant follicle in polycystic ovarian syndrome (PCOS) patients. DESIGN: Comparing ultrasound and estradiol (E2) measurements during treatment with a low-dose protocol (using purified follicle-stimulating hormone, starting with 75 IU/d and increasing every 7 days by 37.5 IU/d) with those obtained following treatment with a conventional protocol using the same drug. SETTING: Specialist Reproductive Endocrine Unit. PATIENTS PARTICIPANTS: Eight PCOS patients of whom six had failed to respond adequately to the conventional protocol. MAIN OUTCOME MEASURE: Rate of cancellation of cycles, number of leading follicles, and serum E2 concentration at the time of ovulation. RESULTS: Treatment with the low-dose protocol resulted in a significant reduction in the number of leading follicles (P less than 0.04), serum E2 concentrations (P less than 0.0002), and a higher rate of ovulation. As a result, five patients conceived compared with none in the conventional protocol. CONCLUSION: Using the low-dose protocol permitted induction of ovulation safely and successfully in a selected group of PCOS patients who were previously difficult to treat with the conventional ovulation induction protocol.
Therapeutic advances in the prevention of hepatitis B: yeast-derived recombinant hepatitis B vaccines. Viral hepatitis is second to gonorrhea as the most commonly reported infectious disease in the US. Hepatitis B accounts for the majority of viral hepatitis cases. Fortunately, the disease is self-limiting and frequently resolves completely with minimal complications; however, a significant number of individuals may experience long-term sequelae. Research utilizing genetic engineering has led to the development of yeast-derived recombinant DNA (YDR) hepatitis vaccines--a significant advancement in the control and prevention of hepatitis B. The recombinant process allows production of unlimited quantities of vaccine at considerably lower cost and without the potential threat of blood-borne illness. Clinical trials in various high-risk populations have demonstrated the effectiveness and safety of YDR vaccines. However, questions regarding optimal regimen and the need for periodic revaccination remain unanswered. Persons at risk should be adequately vaccinated against hepatitis B.
Application of Doppler color flow imaging to determine valve area in mitral stenosis. This study was undertaken to examine whether Doppler color flow imaging could accurately estimate the valve area in mitral stenosis. Doppler color flow assessments were performed in both an in vitro model and in 30 patients with mitral stenosis undergoing cardiac catheterization. In the experimental Doppler study using a circuit model, color jet width correlated well with actual orifice diameter (r = 0.99). In the clinical Doppler study, the mitral valve orifice was assumed to be elliptic and the mitral valve area was calculated from the following equation: (pi/4) (a x b), where a = color jet width at the mitral valve orifice in the apical long-axis view (short diameter) and b = the width in the 90 degrees rotated view (long diameter). Mitral valve area was also determined by two-dimensional echocardiography and the pressure half-time method, and the results for all three noninvasive methods were compared with those obtained at cardiac catheterization. By Doppler color flow imaging, mitral valve area could be determined in all patients and there was a significant correlation between the Doppler jet and catheterization estimates of mitral valve area (r = 0.93). Valve area determined by two-dimensional echocardiography correlated well with catheterization measurements in 26 patients (r = 0.84). However, the area could not be determined in 4 (13%) of the 30 patients because of technical problems. Although there was a fair correlation between the valve area determined by the pressure half-time method and catheterization (r = 0.79), this method tended to overestimate valve area in patients with aortic regurgitation.
Hemangiopericytoma of the spleen. A splenic tumor is reported with the light microscopic, immunohistochemical, and ultrastructural features of a hemangiopericytoma. The findings in this case are compared with the only previously reported splenic hemangiopericytoma. Differences in the clinical presentation and the gross appearance of the two cases are described, and similarities in the microscopic features are discussed.
Changing rates of stroke in the province of Quebec, Canada: 1981-1988. Using more than 37,000 hospital discharges attributed to hemorrhagic or occlusive stroke in the province of Quebec, Canada, we analyzed trends in stroke incidence during the period 1981-1988. There were large and statistically significant (p less than 0.05) increases in the rates of hemorrhagic stroke over this period. Dramatic increases occurred among men in the rates of both intracerebral (International Classification of Diseases--Ninth Revision [ICD9] code 431) and intracranial (ICD9 code 432) hemorrhagic strokes (40-204% depending on age). In contrast, the rates of occlusion of the precerebral arteries (ICD9 code 433) declined in younger men and women but increased substantially (107%) in older men. Rates of occlusion of the cerebral arteries (ICD9 code 434) declined in men over the age of 50 years and in women aged 50-79 years. Despite the decline in the rate of occlusion of the cerebral arteries, the rate of hemorrhagic stroke appears to have increased. Changes in the hospitalization rates for hemorrhagic stroke were not accompanied by consistent decreases in the case-fatality rate. This finding tends to support the hypothesis of an actual increase in the hospitalization rate fo hemorrhagic stroke rather than an artifactually elevated rate due to enhanced diagnosis by computed tomography.
Prevention of coronary heart disease in black adults. Development of strategies to prevent CHD in blacks is impeded by the virtual absence of clinical trials demonstrating the feasibility and effectiveness of interventions in blacks. The wholesale generalization that interventions effective (or ineffective) in whites are similarly effective in blacks may risk the employment of worthless or even dangerous interventions in blacks. Using available epidemiologic data, a number of risk factors may be more important in blacks than whites by virtue of higher prevalence, increased relative risk, or both. These may include hypertension, lipoprotein (a), smoking, diabetes, and obesity. Thus, health agencies might emphasize these risk factors when developing preventive programs targeted at black populations. Prevention programs may best seek to prevent the onset of risk factors found highly prevalent in black communities, rather than the costly and side-effect-prone interventions to treat risk factors once established. Thus, there is a role for community-based as well as a high-risk approaches. The community-based approaches should seek to work with organizations such as churches, which traditionally play strong roles in the black community. Physicians treating black patients should be aware of the potentially different roles played by risk factors, and treat aggressively those individuals identified to be at high risk. Risk factor management should be emphasized, rather than reduced, in patients with already established CHD. CHD has been clearly shown to be preventable; both blacks and whites should benefit from specific interventions aimed toward this worthy goal.
High blood pressure due to alcohol. A rapidly reversible effect. The hypothesis that the action of alcohol on blood pressure is rapidly reversible and that its effect is therefore mainly due to very recent alcohol consumption was examined in this study. Five hundred and seventy-seven subjects were screened in an occupational survey. Alcohol consumption, documented with a 1-week retrospective diary was divided into two categories: "recent" and "previous" intake. Recent intake was defined as the amount consumed on days 1, 2, and 3 immediately preceding blood pressure measurement. Previous intake was defined as the amount consumed on days 4, 5, and 6 preceding blood pressure measurement. High recent alcohol intake significantly raised systolic and diastolic blood pressure in both men and women. Previous alcohol intake, however, did not appear to influence blood pressure. We conclude that the effect of alcohol on blood pressure appears to be predominantly due to alcohol consumed in the few days immediately preceding blood pressure measurement, with alcohol consumption before those few days exerting little effect on blood pressure.
Progesterone receptor in hepatocellular carcinoma. Correlation with androgen and estrogen receptors. Progesterone receptors (PgR), estrogen receptors (ER), and androgen receptors (AR) were assayed consecutively for hepatocellular carcinoma (HCC) that was surgically removed from 19 men and three women. The methods of receptor assay were the enzyme immunoassay (EIA) for PgR and the dextran-coated charcoal (DCC) technique for ER and AR. The patients ranged in age from 32 to 77 years (average, 60.3 years). No patients had received any specific anti-cancer therapy before tissue collection. All patients but one had underlying liver disease: cirrhosis in 13 and chronic hepatitis in eight. The positive rate of each receptor was 18% for PgR, 48% for ER, and 82% for AR. The titer was highest for AR, intermediate for ER, and lowest for PgR. The titers of PgR in four PgR-positive patients ranged from only 1.1 to 3.0 fmol/mg of protein. There was no relationship between PgR, ER, and AR in terms of positivity and titer. Also, other clinical and histopathologic data did not influence the positivity or concentration of these three sex hormone receptors. It can be concluded that no or little PgR exists in the cytosol of untreated HCC.
Relation of left ventricular volume and function over one year after acute myocardial infarction to infarct size determined by technetium-99m sestamibi. Twenty patients with a first acute myocardial infarction (AMI) (15 anterior, 5 inferior) who received successful reperfusion therapy underwent tomographic imaging with technetium-99m (Tc-99m) sestamibi and radionuclide ventriculography at discharge, 6 weeks, and 1 year after AMI. Patency of the infarct-related artery after reperfusion (thrombolysis, 8 patients; coronary angioplasty, 12 patients) was confirmed by angiogrpahy in all patients. Tc-99m sestamibi perfusion defect at discharge (a measure of infarct size) was quantitated using previous methods and expressed as a percentage of the left ventricle (28 +/- 19%, range 0 to 59%). This perfusion defect size correlated closely with ejection fraction at discharge (r = -0.87), 6 weeks (r = -0.81) and at 1 year (r = -0.78, all p less than 0.0001). Perfusion defect size at discharge also correlated closely with end-systolic volume index at discharge (r = 0.71, p less than 0.0005), 6 weeks (r = 0.63, p less than 0.005) and at 1 year (r = 0.76, p less than 0.0001). Perfusion defect size at discharge did not correlate significantly with end-diastolic volume index at discharge or at 6 weeks, but did correlate at 1 year (r = 0.66, p less than 0.005). There was no significant group change in end-systolic or end-diastolic volume indexes from discharge to 1 year later, although 7 patients had definite individual changes in end-diastolic volume index (3 increased and 4 decreased). There was no relation between defect size and late changes in end-systolic volume index, but there was a weak correlation between defect size and late changes in end-diastolic volume index (r = 0.42, p = 0.07).
Relationship of epidermal growth factor receptor detectability with the A, B, H blood group antigens. Emphasis on normal and neoplastic urothelium. The epidermal growth factor receptor (EGFR) is a glycoprotein that carries on its extracellular domains oligosaccharide chains, some of which are similar to blood group determinants. The author examined the expression of the EGFR using immunohistochemistry and three anti-EGFR antibodies with different fine specificities. These were applied to frozen sections from 120 tissue biopsies, including normal and neoplastic urothelium. The expression of blood group A, B, H determinants was also evaluated in the same tissues. Significant differences were noted, depending on the fine specificity of the anti-EGFR antibody, cellular differentiation, and the tissue donor's blood group. The most interesting finding was a reciprocal relationship between the reaction patterns obtained using antibodies with carbohydrate specificity and those with peptide specificity. These patterns were characteristic of cellular differentiation and suggested that the EGFR peptide determinants are detected in excess in immature and malignant cells that, however, appear deficient in oligosaccharide determinants. The combination of 'loss' of blood group antigen and an apparent overexpression of EGFR peptide determinants is indicative of invasive growth in transitional cell carcinomas.
Acantholytic dyskeratotic epidermal naevus in a patient with guttate psoriasis on PUVA therapy. A 79-year-old male with psoriasis developed a zosteriform acantholytic dyskeratotic epidermal naevus during PUVA therapy. The eruption was successfully treated with etretinate 0.75 mg/kg/day and a subsequent course of PUVA with the affected area covered prevented a recurrence of the naevus.
Susceptibility to and severity of rheumatoid arthritis in multicase families. Fifteen sibships, each having two or more siblings affected by classical or definite RA were studied. They comprised 31 patients with RA (all in remission) and 21 normal siblings. The total severity index of RA was assessed by clinical and radiological indices. For all the patients the following investigations were carried out: (1) HLA antigens determination for nine antigens at A locus and 15 at B locus and 6 at DR locus; (2) rheumatoid factor. We found: (1) RA disease is genetically controlled and the responsible genes are linked to the HLA system; (2) association between seropositivity and DR4 and DR4/B27 genotypes; (3) significant effect of the genotype DR4/B27 on the age of onset; (4) association between the increase in disease severity both clinical and radiological and DR4/X and DR4/B27 phenotypes. Thus the genetic control is probably composed of two types of genes: disease susceptibility genes and disease severity genes linked to DR4/X and DR4/B27 phenotypes.
Elevation of plasma concentrations of haloperidol after the addition of fluoxetine. Fluoxetine (20 mg/day) was added for 7-10 days to stable doses of haloperidol given to eight psychotic patients. Mean plasma concentrations of haloperidol were elevated by 20% (p less than 0.05), but extrapyramidal side effects did not increase appreciably, indicating a relatively minor interaction between these agents.
Juvenile progressive systemic sclerosis: report of five cases. Five cases of juvenile progressive systemic sclerosis (SSc) are reported (4 girls and 1 boy). The age of onset of the disease ranged from 4 to 13 years. The clinical features included Raynaud's phenomenon present in 4 of 5 cases; hyperpigmentation, skin tightening and contractures of the large joints were noted in all 5 cases. One patient initially diagnosed as having eosinophilic fasciitis developed SSc 3 months later. Another patient was diagnosed initially as having juvenile rheumatoid arthritis. There was one case of pulmonary fibrosis and another of mild restrictive lung disease. Two cases of esophageal and intestinal hypomotility were reported. Scleroderma nephropathy was absent in all 5 cases.
Colorectal cancer: current trends in initial clinical manifestations. Colorectal carcinoma (CRC) is a common cause of cancer morbidity and mortality in the United States. There continues to be controversy regarding the effectiveness and feasibility of various screening programs for CRC. To determine how cases of CRC are currently detected, we reviewed a series of 246 consecutive patients with well-documented pathologic staging and clinical presentation. Patients with low stage CRC (0 or A) had smaller tumors, were less likely to be anemic at presentation, and were more likely to have tumors located in the left side of the colon than patients with tumors at stage B or higher. Thirty-two of the 246 tumors were detected in asymptomatic patients through screening. These tumors were more likely to be of a lower stage than those in patients with active gastrointestinal symptoms. In our experience active screening programs detect a relatively small number of CRCs. A majority (66%) of CRCs are still detected from symptoms referable to the gastrointestinal tract.
Aggressive juvenile fibromatosis involving the paranasal sinuses. Aggressive juvenile fibromatosis is a destructive, locally invasive process, with a propensity for local recurrence after inadequate excision. Although it does not metastasize, uncontrolled growth can eventually lead to death. The role for radiation and chemotherapy is controversial and these modalities are best reserved for advanced unresectable or recurrent lesions. The treatment of choice is en bloc surgical resection with wide margins.
Cytoprotection and stress ulceration. The stomach possesses many mechanisms for protection against stress ulceration. The gastric microcirculation, prostaglandins, mucus secretion, epithelial cell renewal, and muscle tone are factors involved in gastric cytoprotection. Therapy is partially directed at augmenting these natural physiologic defense mechanisms to prevent and promote healing of stress ulceration. Drugs such as sucralfate, carbenoxalone, colloidal bismuth, and prostaglandins are used. Stress ulceration is an important cause of upper gastrointestinal tract hemorrhage in postoperative and critically ill patients in the intensive care unit setting. Preventive therapy includes neutralization of gastric acid by antacids, suppression of gastric acid secretion by H2-receptor blockers, administration of cytoprotective agents, and correction of the underlying stress state. Active bleeding requires accurate diagnosis by gastroscopy. Additional therapy may be necessary, including intra-arterial administration of vasopressin and occasionally surgery. Dieulafoy's lesion is an unusual stress-related cause for upper gastrointestinal bleeding. The area of mucosal injury is minute but underneath lies a large submucosal gastric artery. It can cause massive bleeding and is often missed at initial gastroscopy. The pathogenesis of Dieulafoy's lesion is complex and the mainstay of therapy has been surgical. Ligation of the vessel, wedge resection, or proximal gastric resection is performed. Therapeutic endoscopy with endoscopic cauterization or injection has changed the approach to this lesion.
Conjugate eye deviation: side, site, and size of the hemispheric lesion. Conjugate eye deviation (CED) is a well-known sign that occurs rather frequently in stroke patients. To study the lateralizing and localizing value of this sign, we investigated prospectively 78 consecutive patients presenting with CED due to a hemispheric lesion. CED occurred more frequently after right-sided hemispheral damage (64%). The lesions in the right hemisphere were located predominantly in the subcortical (fronto-) parietal region and the internal capsule; the lesions in the left hemisphere were larger, covering the entire fronto-temporo-parietal area. In the majority of patients there was no direct involvement of the frontal eye fields on either side. The results indicate that a lesion at different sites within the circuit between the inferior parietal lobule and frontal eye fields, and their projections to the superior colliculus or paramedian pontine reticular formation, can be responsible for CED. The right-left asymmetry is probably related to cerebral asymmetry for directed spatial attention.