shukoor65/lab-rag-model huggingface dataset:
Enhanced immunoglobulin levels correlate with infectious complications after surgery in esophageal cancer. Severe septic complications account for the high mortality of patients with esophageal cancer. We examined the levels of immunoglobulins and complements together with infection-related complications in a large number of patients. Enhancements of IgG, IgA, C3, C4, and CH50 were evident in patients with esophageal cancer and were more predominant compared to findings in cases of gastric cancer. Average levels of IgG and IgA immediately before surgery were significantly higher in esophageal cancer patients with postoperative septic complications than in those without such problems. Preoperative radiation therapy and total parenteral nutrition did not significantly alter the levels of immunoglobulins and complements. It would thus appear that the enhancement of IgG and IgA is associated with the occurrence of infectious complications following surgery for patients with esophageal cancer.
Exercise endurance and arterial desaturation in normobaric hypoxia with increased chemosensitivity. We studied whether exercise endurance under normobaric hypoxia can be enhanced by increasing hypoxic ventilatory sensitivity with almitrine bismesylate (ALM). On both ALM and placebo (PL) days, resting subjects breathed a hypoxic gas mixture (an inspired O2 fraction of 10.4-13.2%), which lowered resting arterial O2 saturation (SaO2) to 80%. After 15 min of rest there was a 3-min warm-up period of exercise at 50 W (light) on a cycle ergometer, followed by a step increase in load to 60% of the previously determined maximum power output with room-air breathing (moderate), which was maintained until exhaustion. With PL, SaO2 decreased rapidly with the onset of exercise and continued to fall slowly during moderate exercise, averaging 71.0 +/- 1.8% (SE) at exhaustion. With ALM, saturation did not differ from PL during air breathing but significantly exceeded SaO2 with PL, by 3.4% during resting hypoxia, by 4.0% at the start of exercise, and by 5.9% at exhaustion. Ventilation was not affected by ALM during air breathing and was slightly, although not significantly, increased during hypoxic rest and exercise. ALM was associated with an increased heart rate during room air breathing but not during hypoxia. Endurance time was 20.6 +/- 1.6 min with ALM and 21.3 +/- 0.9 min with PL. During hypoxic exercise, the potential benefit of greater saturation with ALM is apparently offset by other unidentified factors.
Endoscopic sphincterotomy complications and their management: an attempt at consensus. Despite its relative safety (in comparison with surgery), and undoubted role in many clinical circumstances, biliary sphincterotomy is the most dangerous procedure routinely performed by endoscopists. Complications occur in about 10% of patients; 2 to 3% have a prolonged hospital stay, with a risk of dying. This document is an attempt to provide guidelines for prevention and management of complications, based on a workshop of selected experts, and a comprehensive review of the literature. We emphasize particularly the importance of specialist training, disinfection, drainage, and collaboration with surgical colleagues.
Athletic participation after myocardial revascularization. Possibilities and benefits. Exercise after open heart operation is not only possible but highly desirable. Training increases the efficiency of exercise and therefore decreases myocardial work for any given level of activity. Even before sternal and incisional healing is complete the patient may become physically active. Almost every patient can improve his or her level of fitness safely by following simple guidelines. Exercise treadmill testing is the basis for assessing exercise capacity in cardiac patients. Upper-body exercise is not adequately emphasized in most exercise programs.
Roles of muscularis mucosae and myofibroblasts in the healing process of acetic acid-induced ulcer. The changes in the localization of FITC-phalloidin-positive smooth muscle cells and interstitial cells were studied in control and acetic acid-treated rat fundic mucosa. In the control rats, the FITC-phalloidin-positive cells mostly corresponded to the smooth muscle cells of the muscularis mucosae, and the arteriolar and venular smooth muscle cells. On the other hand, 1 week after the acetic acid treatment, the fluorescence of the smooth muscle cells of the muscularis mucosae disappeared and a large number of fluorescent interstitial cells, probably corresponding to myofibroblasts, appeared in the regenerated mucosal layer. Three weeks after the application, severely thickened fluorescent muscularis mucosae were formed and the fluorescence of the interstitial cells was rather decreased.
Infection of inbred rat strains with Rift Valley fever virus: development of a congenic resistant strain and observations on age-dependence of resistance. A congenic rat strain (WF.LEW) was derived from the susceptible Wistar-Furth (WF) (background strain) and the resistant LEW (donor strain) inbred strains and was used to evaluate the phenotypic expression of a dominant Mendelian gene that confers resistance to fatal hepatic disease caused by the ZH501 strain of Rift Valley fever virus (RVFV). Resistance to hepatic disease developed gradually with age, with full expression at approximately 10 weeks in the WF.LEW and LEW rat strains. The ZH501 strain caused fatal hepatitis in WF rats regardless of age. However, resistance to the SA75 RVFV strain (relatively non-pathogenic for adult rats), was age- and dose-dependent in both WF and LEW rats. The resistance gene transferred to the newly derived WF.LEW congenic rat strain appears to amplify age-dependent resistance of adult rats, resulting in protection against fatal hepatic disease caused by the virulent ZH501 strain. The congenic rat strain will be a valuable asset in elucidating the mechanism of resistance to Rift Valley fever virus governed by the dominant Mendelian gene.
Diagnosis of cysticercosis in endemic regions. The Cysticercosis Working Group in Peru. Taenia solium cysticercosis is a frequent cause of neurological disease in developing countries. Specific diagnosis of cysticercosis is difficult. We obtained serum and/or CSF samples from 204 consecutive patients admitted to a neurological ward in Lima, Peru, and looked for antibodies specific for T solium with the enzyme-linked immunoelectrotransfer blot (EITB) assay. 21 (12%) of 173 serum samples from these patients were EITB-positive. In contrast, only 2 (1.5%) of 135 patients attending a public endoscopy clinic and 1 (1%) of 88 patients attending a private endoscopy clinic were seropositive. 1 (1%) of 98 pregnant women living in a Lima shanty town was EITB-positive. 15 (58%) of 26 neurology patients diagnosed clinically as having cysticercosis were seronegative. Routine screening by EITB of all patients with neurological symptoms from areas of endemic cysticercosis would avoid misdiagnosis of this common and treatable disease.
Function of the diabetic retina after panretinal argon laser photocoagulation. Influence of the intensity of the coagulation spots. To investigate the influence of the intensity of coagulation spots on retinal function and the clinical course after panretinal argon laser photocoagulation in diabetic retinopathy, we conducted a prospective study in 24 eyes of 12 diabetics. One eye was treated with moderate spots (average: 300 mW), the fellow eye was coagulated with intense spots (average: 600 mW). The spot size was identical in both eyes. Subjective parameters (visual acuity, perimetry), as well as objective functions (ERG, EOG) and the clinical course, were studied preoperatively and on a regular base with a follow-up of 12 months. Visual acuity and fundus findings deteriorated less often in eyes coagulated with intense spots. Visual field loss, however, was more prevalent in eyes treated with intense spots. Early treatment complications only occurred with high-energy coagulation. For this reason, high-energy spots should not be used even though they might be indicated theoretically.
Association of a precore genomic variant of hepatitis B virus with fulminant hepatitis. A variant of hepatitis B virus has been described recently in HBsAg+ Mediterranean patients who lack HBeAg and who have an unusual and severe form of chronic hepatitis. This variant is unable to produce HBeAg because of the presence of a novel translational stop codon at the end of the precore region of the genome. By direct sequencing of DNA, generated by the polymerase chain reaction, we have evaluated the association between infection with this variant and the fulminant course of hepatitis B. Eighteen patients with fulminant hepatitis B were studied. Of the 15 cases from whose serum viral DNA could be sequenced, the variant was found in the admission sera of 8 of 9 HBeAg- patients but in none of 6 HBeAg+ patients who had fulminant hepatitis B. Patients harboring the variant progressed more rapidly into hepatic encephalopathy, but those infected with the variant strain alone had a greater likelihood of survival than those infected with the normal strain or a mixture. The mutant strain may emerge spontaneously during fulminant hepatitis as occurs in chronic hepatitis B infection during seroconversion from HBeAg to antibody. Alternately, and perhaps less commonly, patients may be infected with the variant ab initio.
Infectious and inflammatory processes of the spine. Infectious and inflammatory processes of the spinal column are discussed, including disc space infection, osteomyelitis, epidural abscess, arachnoiditis, and rheumatoid arthritis. The relative sensitivity and specificity of various imaging modalities, as well as the imaging characteristics and utility of these various modalities are given. Emphasis is placed on the use of magnetic resonance imaging.
Intrathoracic osteosarcoma diagnosed by CT scan and pleural biopsy. Osteosarcoma rarely presents as a primary lesion in the chest, whereas pulmonary metastases are common. The diagnosis of primary intrathoracic osteosarcoma has invariably been by thoracotomy or autopsy. We present a case of a densely calcified, primary intrathoracic osteosarcoma where diagnosis was made antemortem by pleural biopsies and computed tomography scan.
Diffuse mesangial sclerosis in a fetus. An 18-week fetus was born following termination of pregnancy by prostaglandin induction. Pregnancy was terminated because of elevated maternal serum alpha-fetoprotein and ultrasonographic evidence of severe oligohydramnios, intrauterine growth retardation, non-visualization of the bladder, dolichocephaly and possible mild hydrocephalus. Pathologic examination disclosed diffuse mesangial sclerosis and histologic evidence of the nephrotic syndrome. To our knowledge this is the first reported example of ante-natal diffuse mesangial sclerosis; of fetal congenital nephrosis other than Finnish type; and of fetal congenital nephrosis with prominent glomerular lesions.
The zinc-reversible antimicrobial activity of neutrophil lysates and abscess fluid supernatants. There is some evidence to suggest that microbial growth inhibition may occur in chronic abscesses. A substance perhaps responsible for this phenomenon is calprotectin, a neutrophil cytoplasmic protein that inhibits microbial growth and that belongs to a class of proteins often having specific binding sites for zinc. In the present study, the suppressive effects of either human or mouse neutrophil lysates on Candida albicans growth were found to be completely reversed by micromolar quantities of zinc but not by iron or other trace elements. Similarly, supernatants of exudates from experimental abscesses in mice or from clinical specimens of abscesses in humans markedly inhibited the proliferation of C. albicans, and this effect was also completely reversed by zinc. A protein complex characteristic of calprotectin was identified in the abscess fluids. Preparations of the neutrophil growth-inhibiting protein, containing predominantly calprotectin, were shown to have zinc-binding activity by a dialysis technique. These findings suggest that the major mechanism of C. albicans growth inhibition by abscess fluids is through competition for zinc by a cytoplasmic protein apparently released from dying neutrophils.
Acute atraumatic subdural hematoma associated with moyamoya disease in an African-American. A 57-year-old black woman with an atraumatic subdural hematoma was treated for congestive heart failure and was found to have moyamoya disease. The association of these two lesions is rare and has never been described in an African-American. High cerebral venous pressures and changes in cerebral perfusion caused by congestive heart failure and the loss of cerebrovascular autoregulation in moyamoya disease may explain the spontaneous occurrence of a subdural hematoma. Recommendations for management are discussed.
Management of radionecrosis of the vulva and distal vagina. Twelve patients were seen between January 1983 and June 1989 with the clinical diagnosis of radionecrosis of the vulva or distal vagina. Seven patients received radiation for vulvar cancer, three for distal vaginal cancer, and two for recurrent endometrial cancer. No patient healed spontaneously and the mean delay in surgical therapy was 8.5 months. The radionecrotic site was treated with local therapy, radical local excision (with or without colostomy), or exenteration. The operative defect was closed primarily in three patients and covered with local flaps or myocutaneous flaps in seven patients. The two patients with local care still have radionecrotic ulcers. One of three patients who were closed primarily continues to have an ulcer. All other patients have healed satisfactorily except one who died after two attempts to correct the problem. Radionecrosis of the vulva and distal vagina should generally be treated surgically.
Primary resection and anastomosis in obstructed descending colon due to cancer. Intraoperative colonic irrigation followed by one-stage resection is gaining popularity as the optimal surgical treatment for left-sided colonic obstruction. However, its efficacy and potential hazards have not been adequately tested in obstruction due to colonic cancer. We analyzed the early results of 23 consecutive patients with obstructive left-sided colonic carcinoma treated by primary resection and anastomosis following intraoperative antegrade colonic lavage. Two patients (8.6%) died, one from complication of anastomotic leakage. The significant postoperative complications were chest infection in three (13%) and wound infection in seven (30.4%). The average hospital stay was 16.5 days. The results of this study suggest that intraoperative bowel irrigation permits one-stage resection and anastomosis to be conducted with reasonable safety provided care is taken in operative techniques.
Phacoemulsification combined with pars plana vitrectomy. Phacoemulsification combined with pars plana vitrectomy was performed on seven patients with both cataracts and vitreoretinal disease. Six of the seven had a posterior chamber intraocular lens (PC-IOL) placed in the capsular bag following cataract extraction. Visual acuities ranging from light perception to hand movement preoperatively, postoperatively ranged from hand movement to 20/25. There were no perioperative complications. During an average follow-up of more than 6 months, neovascular glaucoma developed in one patient, and a conjunctival cyst in another. The PC-IOLs were well tolerated. The small limbal incision used in phacoemulsification allows better control during the vitrectomy procedure and ensures a water-tight wound. In addition, with the limbal approach, the posterior lens capsule is maintained, with all the attendant advantages.
A phase I trial of recombinant human interleukin-1 beta alone and in combination with myelosuppressive doses of 5-fluorouracil in patients with gastrointestinal cancer. We studied escalating doses of recombinant human interleukin-1 beta (IL-1 beta) alone and after a myelosuppressive dose of 5-fluorouracil (5-FU) in patients with gastrointestinal cancer. Transient neutropenia, monocytopenia, and lymphocytopenia were observed followed by a 1.3- to 6.0-fold (mean, 3.46-fold) dose-dependent neutrophil leukocytosis (P less than .00001) on the days of IL-1 beta administration. Increases in platelet counts were observed at a median of 14 days (range, 6 to 23) after IL-1 beta administration. Transient hypoglycemia, rebound hyperglycemia, elevations in serum cortisol, and C-reactive protein were observed. Side effects included fever, rigors, and headache in the majority of patients. Hypotension was observed in three of five patients at the highest dose level (0.1 micrograms/kg) and was dose-limiting. Fewer days of neutropenia were noted after 5-FU plus IL-1 beta than after 5-FU alone; however, this difference did not reach statistical significance. These data show that IL-1 beta has stimulatory effects in human hematopoiesis.
Sleep apnea in patients with acute myocardial infarction. OBJECTIVE: To document sleep apnea in the acute phase of myocardial infarction. If apnea occurs in patients with myocardial infarction, hypoxemia induced by apnea might exaggerate insufficiency of oxygen supplied to the damaged myocardium. DESIGN: Prospective controlled study. SETTING: Critical care unit of a teaching hospital. PATIENTS: Forty-nine patients, average age 64 yrs (range 49 to 91). MEASUREMENTS AND MAIN RESULTS: Patient measurements were recorded on a polygraph using an apnea-monitor, pulse oximeter, pulmonary artery pressure monitor, and an ECG. All of the patients observed showed frequent apneic episodes. The apnea was especially frequent when the cardiac index was low. Capillary oxygen saturation of less than 90% (suggesting systemic hypoxia) was observed in 21 patients concomitantly with apnea. Occasionally, arrhythmias followed these episodes (premature supraventricular contractions [n = 10], premature ventricular contraction [n = 4], and ventricular tachycardia [n = 2]). CONCLUSIONS: This study suggests that sleep apnea is common in the setting of acute myocardial infarction. It may be a factor predisposing to, or even causing, sudden death in patients with acute phase of myocardial infarction.
Choanal atresia and lymphedema. The coexistence of bilateral bony choanal atresia and lower-extremity lymphedema was observed in a family with several consanguineous marriages. The combination of these two rare anomalies, in a hereditary form, has not been described before.
Clinical overview of management of chronic ischemic heart disease. The outcome of patients with chronic coronary artery disease is dependent on many factors; the most important ones include the severity and extent of coronary artery disease, state of left ventricular function at rest, extent and severity of myocardial ischemia, and the total amount of left ventricular myocardium that is at risk. To use noninvasive tests optimally, the clinician first must define the information needed. The sensitivity, specificity, and predictive accuracy of the test(s) in providing the necessary information, the additive value of the result of a test to the information already available, and the best combination of tests in providing the desired information help determine the choice of various noninvasive tests in a particular clinical circumstance.
A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. The Northern New England Cardiovascular Disease Study Group. OBJECTIVE--A prospective regional study was conducted to determine if the observed differences in in-hospital mortality rates associated with coronary artery bypass grafting (CABG) are solely the result of differences in patient case mix. DESIGN-Regional prospective cohort study. Data including patient demographic and historical data, body surface area, cardiac catheterization results, priority of surgery, comorbidity, and status at hospital discharge were collected. This study presents data for 3055 CABG patients between July 1, 1987, and April 15, 1989. SETTING--This study includes data from all surgeons performing cardiothoracic surgery in Maine, New Hampshire, and Vermont; the data were collected from five regional medical centers. PATIENTS--Data were collected from all consecutive isolated CABG surgery patients during the study period. MAIN OUTCOME MEASURES--Crude and adjusted in-hospital mortality rates associated with CABG. MAIN RESULTS--The overall crude in-hospital mortality rate for isolated CABG was 4.3%. The rate varied among centers (range, 3.1% to 6.3%) and among surgeons (range, 1.9% to 9.2%). Predictors of in-hospital mortality included increased age, female gender, small body surface area, greater comorbidity, reoperation, poorer cardiac function as indicated by a lower ejection fraction, increased left ventricular end diastolic pressure and emergent or urgent surgery. After adjusting for the effects of potentially confounding variables, substantial and statistically significant variability was observed among medical centers (P = .021) and among surgeons (P = .025). CONCLUSION--We conclude that the observed differences in in-hospital mortality rates among institutions and among surgeons in northern New England are not solely the result of differences in case mix as described by these variables and may reflect differences in currently unknown aspects of patient care. Understanding this variation requires a detailed understanding of the processes of care.
Tumor necrosis factor-alpha inhibits 1,25-dihydroxyvitamin D3-stimulated bone Gla protein synthesis in rat osteosarcoma cells (ROS 17/2.8) by a pretranslational mechanism. Tumor necrosis factor-alpha (TNF alpha), a 17,000 mol wt protein, mediates a variety of immunological and inflammatory events. TNF alpha is a potent inhibitor of bone collagen synthesis and stimulator of osteoclastic bone resorption, the net effect of which is to cause bone loss. We have previously reported that TNF alpha inhibits the synthesis of collagen by osteoblastic cells in culture out of proportion to effects on total protein synthesis, suggesting that inhibition of bone formation by TNF alpha may be due to selective inhibition of matrix protein synthesis. To further test this hypothesis and to evaluate the mechanism of TNF alpha action, we studied the effect of TNF alpha on synthesis of the osteoblast-specific bone Gla protein (BGP) by ROS 17/2.8 cells, which have the osteoblast phenotype. Cells were cultured with 10 nM 1,25-dihydroxyvitamin D3 to stimulate BGP secretion, followed by the addition of TNF alpha (1-100 ng/ml) in 1,25-dihydroxyvitamin D3-containing medium. TNF alpha (10 ng/ml) inhibited BGP secretion to 42 +/- 5%, 19 +/- 10%, and 15 +/- 3% of control values after 24, 48, and 72 h of treatment. After 48 h, inhibition of BGP secretion was observed with 2 ng/ml TNF alpha and was maximum with 100 ng/ml. To determine the effect of TNF alpha on total protein synthesis, cells were pulse labeled with [14C]leucine during the last 4 h of TNF alpha treatment, and incorporation of radioactivity into trichloroacetic acid-precipitable protein in cell layer and medium was determined. The TNF alpha inhibition of BGP secretion was independent of changes in [14C]leucine incorporation, suggesting that TNF alpha did not have a general inhibitory effect on total protein synthesis. Cell number was not affected by TNF alpha. Northern analysis of steady state BGP mRNA revealed a dose-dependent decrease in the BGP/cyclophilin mRNA hybridization signal intensity after 24 h of treatment. The maximum inhibitory effect was 41 +/- 5% of the control value with 100 ng/ml TNF alpha. The effect of TNF alpha on steady state BGP mRNA levels was not prevented by treatment of cells with cycloheximide, suggesting that TNF-induced new protein synthesis was not required for TNF alpha action. These results suggest that the mechanism of TNF alpha inhibition of BGP synthesis includes a pretranslational site and support the hypothesis that TNF alpha inhibits bone formation by a selective inhibition of matrix protein production.