shukoor65/lab-rag-model huggingface dataset:
Decreased Gs alpha mRNA levels accompany the fall in Gs and adenylyl cyclase activities in compensated left ventricular hypertrophy. In heart failure, only the impairment in adenylyl cyclase activation progresses. We have previously reported that there is a global reduction in adenylyl cyclase associated with a decrement in Gs functional activity in cardiac sarcolemma from animals with pressure overload-induced hypertrophy and heart failure. This study was performed to determine whether hypertrophy alone in the absence of heart failure is sufficient to promote these changes and whether the superimposition of heart failure intensified these changes. Basal and stimulated adenylyl cyclase and Gs activity, as determined in the S49 cyc- reconstitution assay, were measured in sarcolemma from normal (NL), left ventricular hypertrophy (LVH) and heart failure (HF) animals. Simultaneously, we measured the mRNA level encoding for the Gs alpha subunit. These studies indicate that Gs activity and Gs alpha mRNA are decreased by approximately 30% both in the failing heart and even in the heart with compensated hypertrophy before heart failure develops (Gs activity, pmol cyclic AMP/10 min per microgram, NL 4.2 +/- 0.4, LVH 3.0 +/- 0.2, HF 3.2 +/- 0.3; Gs alpha mRNA, pg/10 micrograms RNA, NL 131 +/- 9.0, LVH 104 +/- 7.4, HF 97.4 +/- 9.1; P less than 0.05 as compared with NL for LVH and HF). Accompanying this decrement in Gs activity is a fall in adenylyl cyclase, both basal and stimulated. However, we also identified a further decrease in adenylyl cyclase without any additional change in Gs or in its alpha subunit mRNA level. This is seen only in the sarcolemma from animals with heart failure as compared with those with compensated LV hypertrophy (e.g., NaF-stimulated activity, pmol cyclic AMP/min per mg, NL 420.2 +/- 17.5, LVH 347.1 +/- 29.6, HF 244.2 +/- 27.3; P less than 0.05 compared with NL for LVH and HF, P less than 0.05 compared with LVH for HF). In summary, these studies indicate that both Gs and adenylyl cyclase activities fall in parallel with the development of LV hypertrophy followed by a further decrement in adenylyl cyclase, independent of Gs, in the setting of heart failure.
A controlled study of low and high volume anesthetic jelly as a lubricant and pain reliever during cystoscopy. To evaluate the influence of the volume of 2% lidocaine jelly as an anesthetic during cystoscopy 241 men and women received either 11 or 20 ml. jelly intraurethrally in a randomized, double-blind fashion. Pain was recorded on a visual analogue scale by the patient and on a 3-level scale by the physician. The pain scores according to the visual analogue scale were significantly higher in the patients given 11 ml. jelly than in those given 20 ml. when all patients in the study were analyzed. There was no significant difference in the visual analogue scale between the 2 treatments in women but a significant difference was noted in men, although in men older than 55 years the difference was not statistically significant. There was general agreement between the visual analogue scale results and the physician scores but the visual analogue scale procedure was more sensitive in detecting differences between treatments. It is suggested that approximately 11 ml. 2% lidocaine jelly is the appropriate volume for women and 20 ml. is the appropriate volume for men during cystoscopy but that the lower volume of jelly may be sufficient in older men.
Localized vs generalized pyogenic granuloma. A clinicopathologic study. We herein report the unusual case of a previously healthy young man who had spontaneous development of multiple lobular capillary hemangiomata disseminated over the integument. Based on the observation that the single lesions exhibited (immuno)pathologic and ultrastructural features similar, if not identical, to those of late-stage pyogenic granulomas, we propose to nosologically include our patient's eruption within the disease spectrum of pyogenic granuloma. As opposed to the occurrence of localized forms of pyogenic granuloma, the disseminated eruption seen in our patient and in other patients whose cases are reported in the literature cannot be ascribed to physical trauma. As some of these latter patients suffered from an underlying malignant neoplasm, it is tempting to speculate that both exogenous (eg, trauma) and endogenous (eg, tumor cells) factors can lead to the release of mediators promoting the development of these vascular neoplasms.
Preoperative diagnosis by enteroclysis of unsuspected closed loop obstruction in medically managed patients. Initial observation and evaluation of patient progress have reduced the number of operative interventions in the management of small intestinal obstruction. The differentiation of simple mechanical from strangulating obstructions has remained difficult. Strangulation is not an invariable component of a closed loop obstruction. We report 27 patients with small bowel obstruction initially managed nonsurgically, in whom enteroclysis 2-8 days after admission demonstrated unsuspected closed loop obstruction. In 25 of the 27 patients, subsequent surgery confirmed the radiologic diagnosis: all the obstructed loops were viable and there was no operative mortality. Our experience suggests that the early performance of enteroclysis should be considered in patients with small bowel obstruction undergoing a trial of nonoperative management.
The effects of low doses of n-3 fatty acid supplementation on blood pressure in hypertensive subjects. A randomized controlled trial. The potential antihypertensive effects after prolonged use of small doses of fish oils remain undefined. Therefore, we conducted a randomized, double-blind, controlled crossover study comparing low doses of n-3 fatty acid supplementation with n-6 fatty acids on blood pressure in 33 subjects with mild hypertension. After a 6-week stabilization period, subjects ingested either 2.04 g/d of n-3 fatty acids or safflower oil (4.8 g/d of linoleic acid) for 12 weeks, then crossed over to the alternative encapsulated oil for another 12 weeks, after a 4-week washout period. All antihypertensive drug therapy had been discontinued. For the combined data, there were significant reductions from pretreatment values for supine diastolic (-2.4 mm Hg) and sitting systolic (-4.1 mm Hg) blood pressure after fish oil; no significant changes occurred after safflower oil control. Compared with safflower oil, fish oil supplementation was associated with a statistically significant reduction in mean supine diastolic blood pressure of 3.7 mm Hg (95% confidence interval, -7.3 and 0.1). Sitting diastolic and mean arterial pressures showed a sequence effect; therefore, only the initial period was used in an analysis of their responses. There were significant decreases from pretreatment values for sitting diastolic (-4.4 mm Hg), mean arterial (-5.1 mm Hg), and systolic (-6.5 mm Hg) blood pressure after fish oil. The differences between groups after the 12-week period remained statistically significant for sitting diastolic and sitting mean arterial blood pressures. No adverse changes were noted in plasma levels of lipid-related measures.
Helium-oxygen and conventional mechanical ventilation in the treatment of large airway obstruction and respiratory failure in an infant. The application of 70% helium-30% oxygen mixtures by tight-fitting face mask in the emergency management of large airway obstruction is well known. We present the case of an infant with severe large airway obstruction and respiratory failure that was unresponsive to the more traditional approaches of airway management, including the delivery of He-O2 by face mask, endotracheal intubation, and conventional mechanical ventilation with oxygen alone. This case was successfully managed with He-O2, when concentrations of O2 were lower than those previously reported in association with conventional mechanical ventilation, until the obstruction could be surgically corrected. We suggest using a new combination of the low-density helium-oxygen gas mixtures and conventional mechanical ventilation, both of which are readily available in most intensive care units.
Hemorrhage following mandibular osteotomies: a report of 21 cases. Hemorrhage associated with mandibular osteotomies, especially to the extent that it becomes life threatening, is a rare occurrence and its risk is less than that following maxillary orthognathic surgery. Twenty-one cases of significant bleeding following mandibular sagittal split ramus osteotomies, vertical and oblique ramus osteotomies, and genioplasties are presented. Life-threatening hemorrhage associated with mandibular osteotomies is primarily an intraoperative problem and the incidence of major postoperative and recurrent hemorrhage is not as great as following maxillary osteotomies. Suggestions for the avoidance and treatment of these bleeding complications are discussed.
Phase I trial of H65-RTA immunoconjugate in patients with cutaneous T-cell lymphoma. H65-RTA is an immunoconjugate that consists of the A chain of ricin (RTA), a ribosomal-inhibiting protein, coupled to a murine monoclonal antibody (H65) directed against the pan-T-cell antigen CD5. The CD5 antigen is heterogeneously expressed on cutaneous T-cell lymphoma tumor cells, but is not expressed on normal cells except lymphocytes. A phase I trial was therefore conducted in which 14 patients with cutaneous T-cell lymphoma progressive on other therapies were treated with up to three cycles of H65-RTA. The maximal tolerated dose (MTD) of H65-RTA was 0.33 mg/kg/d administered intravenously for 10 days as defined by dyspnea at rest at higher doses. Other reversible side effects included myalgia, mild hypoalbuminemia with weight gain, pedal edema, fatigue, fevers, and chills. Six patients received more than one cycle of H65-RTA without increased side effects compared with the first cycle. Pharmacokinetic analysis showed that peak serum drug levels were dose-dependent, and ranged from 1.13 to 5.56 micrograms/mL, with a terminal half-life ranging from 1.0 to 2.9 hours. The development of antibodies against the immunoconjugate was associated with a lower peak drug level, but not with enhanced side effects. Partial responses lasting from 3 to 8 months were documented in four patients. Three of the responding patients received more than one cycle of H65-RTA in the presence of anti-immunoconjugate antibodies. The results from this phase I trial suggest that H65-RTA is an active drug in the treatment of cutaneous T-cell lymphoma. The immunoconjugate may be safely administered repeatedly, even in the presence of anti-immunoconjugate antibodies, with responses noted. Additional studies at the MTD are needed to define the response rate in this disease.
Human papillomavirus DNA types in squamous cell carcinomas of the head and neck. Previous studies have found variable evidence suggestive of a role for human papillomavirus (HPV) in squamous cell carcinoma of the head and neck. In this study 49 cases of primary verrucous or squamous cell carcinoma from patients referred to a regional medical center were examined initially by Southern blot hybridization to detect HPV types 2, 6, 11, 13, 16, 18, and 32. Approximately 60% of carcinomas from certain head and neck sites, particularly the floor of the mouth, tongue, pharynx, piriform sinus, and larynx, were positive for episomal viral DNA of HPV-6, -11, -16, or -18. HPV DNA was found in some multiple tumors from separate sites of the same patient. Integration of viral DNA into the host cell chromosome was likely in a minority of the positive carcinomas, and no novel HPV DNA types were indicated by the hybridization analyses. Subsequently, DNA remaining from 30 of the carcinomas was examined by a more sensitive polymerase chain reaction amplification assay for DNA of HPV-6, -11, -16, and -18. Twenty-seven of the samples were positive for one or more HPV DNA types, with all positive carcinoma samples containing oncogenic HPV-16 or -18 DNAs. Almost all the patients examined were of the middle to older age group with a history of tobacco use. Although HPV infection of oral mucosa may be a frequent occurrence, a possible role for HPVs in the multifactorial etiology of head and neck carcinogenesis merits further epidemiologic investigation.
Bilateral optic disc neovascularization in association with retinitis pigmentosa. Bilateral neovascularization of the optic disc developed in a 16-year-old Hispanic girl with retinitis pigmentosa. The neovascularization regressed in both eyes over 1 year without treatment. Ocular and systemic evaluation failed to reveal a recognized cause for the neovascularization. To our knowledge this is only the third case reported of this unusual association.
Epidural fentanyl does not influence intravenous PCA requirements in the post-caesarean patient. Forty ASA physical status I or II patients scheduled for elective Caesarean delivery were studied to determine the effect of epidural fentanyl on post-Caesarean delivery analgesic requirements as administered by intravenous patient-controlled analgesia (PCA). Following delivery of the infant, under epidural anaesthesia with lidocaine 2% with 1/200,000 epinephrine, patients were randomly assigned to receive either 10 ml of preservative-free normal saline via the epidural catheter or 100 micrograms of fentanyl with 8 ml preservative-free normal saline in a double-blinded fashion. On arrival in the post-anesthesia recovery room (PAR), patients were provided with intravenous PCA meperidine 12.5 mg every eight minutes as needed. Patients were visited at intervals over the next 24 hr to determine if any differences in narcotic requirements, demands for narcotics, or severity of pain were noted. No differences were observed in any values between the groups. It is concluded that a single bolus of epidural fentanyl does not provide an advantage for postoperative pain relief in this patient population.
Inhibitor of the thrombin time in systemic amyloidosis: a common coagulation abnormality. Patients with primary systemic amyloidosis (AL) often experience bleeding, and we report a newly recognized coagulation abnormality in AL. Of 103 patients with primary systemic AL studied over 2 years, 41 had prolongation of the thrombin time (range, 25 to 46 seconds; normal, less than 22 seconds) and reptilase time (range, 17 to 39 seconds; normal, 14 to 16 seconds). The fibrinogen from the plasma of 36 patients was precipitated by beta-alanine and diluted to a concentration of approximately 200 mg/dL. The thrombin times of the precipitated fibrinogens were normal in 34 patients, implying that an inhibitor was responsible for the abnormal tests. The addition of patient fibrinogen-free plasma to normal plasma prolonged the thrombin times, and this result confirmed the presence of an inhibitor. The inhibitor is more likely to be present in patients with nephrotic syndrome (20 of our patients) and congestive heart failure (six). A circulating monoclonal protein (24 patients), the presence of amyloid liver involvement (eight), and the presence of amyloid neuropathy (nine) were not predisposing factors. Only one patient had deficiency of factor X. We conclude that inhibition of fibrinogen conversion to a fibrin clot rather than dysfibrinogenemia is the cause of the prolonged thrombin time in primary systemic AL.
Comparative morphologic and immunohistochemical studies of estrogen plus alpha-naphthoflavone-induced liver tumors in Syrian hamsters and rats. Syrian hamsters were treated with ethinylestradiol and maintained on a diet containing alpha-naphthoflavone (alpha NF), a regimen that produces a high incidence of liver tumors. Morphologic analyses (light microscopy, immunoperoxidase studies, and electron microscopy) were performed on livers of these animals. After 4 months of hormone plus alpha NF treatment, marked hepatocyte cell changes were already present, as demonstrated by loss of eosinophilic staining of hepatocyte cytoplasm. Large multinucleated hepatocytes exhibiting frequent mitoses were observed around central veins. After 5 months of treatment, there was proliferation of bile ducts, and small cells with eosinophilic cytoplasm resembling hepatocytes appeared surrounding these bile ducts. At 7 to 8 months, the first tumor nodules (foci) were seen. Tumor foci in the portal area consisted of small clusters of large cells resembling hepatocytes with irregular nuclei. At the same time, dysplastic glands were identified among proliferating bile ducts. By 8 to 10 months, large tumors were present. These were trabecular hepatocellular carcinomas with widely varying individual cell morphology. Compared with adjacent liver, dysplastic glands in the portal areas, microcarcinomas, and large tumors all showed intense immunostaining for cytokeratin. Rats treated with the same regimen also developed hepatic tumors, but the light and electron microscopy results and immunohistochemical profiles were very different. Altered hepatic foci composed of small hepatocytes were typically prominent; however, malignant tumors did not arise from the portal area. Neither altered foci nor tumors stained significantly for cytokeratin. These data suggest that the biochemical events giving rise to these liver tumors differ between the species studied, despite the animals being exposed to the same treatment regimens.
Transmural distribution of myocardial tissue growth induced by volume-overload hypertrophy in the dog. BACKGROUND. Although chronic volume overload is thought to induce uniform cardiac enlargement, the stimulus for tissue growth has not been defined. Changes in diastolic and systolic stress or strain have been proposed as mechanical factors that may stimulate hypertrophy. Since there are thought to be transmural variations in these stresses and strains, three-dimensional patterns of myocardial tissue growth may provide insight into the role of these factors. METHODS AND RESULTS. To assess the transmural variation in tissue growth after volume overload, the configurations of three columns of four to six gold beads (1-mm diameter) implanted in the left ventricular anterior free wall were recorded in five dogs before and after cardiac enlargement induced by creating a systemic arteriovenous fistula. Data were obtained with end-diastolic pressures adjusted to the same level in the control and hypertrophic states. End-diastolic wall thickness remained constant, whereas left ventricular diameter increased. Small increases in transmural systolic strain were seen. The volumes defined by four beads (a tetrahedron) at end diastole showed increases in myocardial mass of 20-27% after 3.6 (mean) weeks of hypertrophy and were uniform across the wall of the left ventricle. The edges of single bilinear-quadratic finite elements were fitted to the three columns of the bead set at end diastole in control and at end diastole after hypertrophy at equal end-diastolic pressures. Thus, continuous transmural strain distribution were obtained at the hypertrophic state with respect to the control state. The transmural distributions of these end-diastolic growth strains were uniform and positive for both the circumferential and longitudinal components measured in a cardiac coordinate system, with small radial growth strain indicating that growth was predominantly parallel to the epicardial tangent plane. Moreover, when strains were transformed (rotated) to fiber coordinates, in-plane fiber and cross-fiber growth strains were both positive at all locations across the wall and approximately equal in magnitude, indicating considerable growth in the cross-fiber direction. CONCLUSIONS. These results indicate that the stimulus for volume-overload hypertrophy may be constant across the wall and that substantial cross-fiber growth occurs during volume-overload hypertrophy.
Cell kinetics by bromodeoxyuridine labeling and deoxyribonucleic acid ploidy in prostatic carcinoma needle biopsies. We studied 63 prostate carcinomas in needle biopsies after labeling in vitro by incubating the entire biopsy specimen with tritiated thymidine or bromodeoxyuridine before fixation. Biopsies from 176 patients were labeled, of which 98 were benign and 78 were carcinomas (15 carcinomas were excluded because of scant tissue). The procedure did not interfere with histological diagnosis. Median labeling index was 0.87% (range 0.1 to 29.3%). A labeling index exceeding 3% was unusual but it may indicate the potential for rapid clinical progression. Deoxyribonucleic acid (DNA) flow cytometry was performed on the last 44 carcinomas using cells shed by the prostatic needle biopsy tissue samples during transportation to the pathology laboratory. A sufficient number of cells were obtained for analysis in 37 cases, of which 6 were DNA aneuploid. Labeling index correlated with Gleason histological grade and score, and data from the 6 DNA aneuploid carcinomas suggest association between DNA aneuploidy and a high labeling index. Estimates of percentage of S-phase cells by flow cytometry did not correlate with variables other than DNA index, and appear to have been affected by a high noise-to-signal ratio (few proliferative cells relative to cellular debris) and inability to discriminate between benign and carcinomatous cells.
Long-term ambulatory cassette EEG with sphenoidal recording in complex partial seizures. Long-term ambulatory cassette EEG with sphenoidal recording (A/EEG-SP) was performed in 51 patients. Group A comprised 31 patients with a clinical diagnosis of complex partial seizures (CPS), and group B comprised 20 patients suspected of having CPS. In group A, detection of temporal spikes was 27% by routine EEG (R/EEG), 72% by sphenoidal EEG (SP/EEG), 27% by A/EEG with temporal chain montage, and 91% by A/EEG-SP. The highest yield achieved by A/EEG-SP as compared with other EEG recordings was documentation of spontaneous seizures of temporal lobe origin. The detection rate of spontaneous seizures by A/EEG-SP was approximately 30%, and the focal or regional onset of seizures could be determined in 60% of patients. In group B, detection of temporal spikes was 11% by R/EEG, 18% by SP/EEG, and 30% by A/EEG-SP. Spontaneous seizures were recorded by A/EEG-SP in two patients (10%). Thus, A/EEG-SP was more effective than A/EEG in detecting interictal and ictal temporal discharges, and A/EEG-SP was superior to SP/EEG in documenting spontaneous seizures of temporal lobe origin.
Pentavalent technetium-99m-DMSA uptake in a patient having multiple myeloma without amyloidosis. A pentavalent 99mTc-dimercaptosuccinic acid (DMSA) scan was performed on a patient with multiple myeloma without amyloidosis. A high accumulation of the tracer was found in numerous tumors. We believe that the accumulation of DMSA is unrelated to amyloidosis and that the DMSA scan may have potential for the staging of tumors in patients presenting with multiple myeloma.
The influence of the menstrual cycle and pregnancy on atopic dermatitis. The prevalence of a premenstrual deterioration in the symptoms of atopic dermatitis, as determined by a postal questionnaire completed by 150 women, was 33%. There was a significant association between a premenstrual worsening of atopic dermatitis and the presence of the symptoms of the premenstrual syndrome (P less than 0.002). Pregnancy had an adverse effect on atopic dermatitis in the majority of cases (52%), usually starting in the first 20 weeks of gestation, although an appreciable proportion of women (24%) had improved during their pregnancy.