shukoor65/lab-rag-model huggingface dataset:
Renal cell carcinoma with inferior vena caval involvement. Renal cell carcinoma extends into the lumen of the inferior vena cava in approximately 4% of patients at the time of diagnosis. Surgical removal of the intracaval tumor thrombus with radical nephrectomy is the preferred treatment for this malignancy. From January 1977 to June 1990, 31 such patients were examined for combined problems of renal carcinoma and intracaval tumor extension. Twenty-six of these patients underwent radical nephrectomy and vena caval thrombectomy. Ten patients had tumor thrombus confined to the infrahepatic vena cava, 11 had retrohepatic caval involvement, and 5 had extension to the level of the diaphragm or into the right atrium. Surgical approach was dictated by the level of caval involvement. Control of the suprahepatic vena cava plus temporary occlusion of hepatic arterial and portal venous inflow were necessary in some cases; cardiopulmonary bypass was required for transatrial removal of more extensive tumors. Five of the 26 patients had evidence before operation of distant metastatic disease; none of these survived beyond 12 months. The 5-year actuarial survival rate of the 21 patients without known preoperative metastatic disease was 57%. Complete surgical excision of all gross tumor appears to be critical for long-term survival in these patients.
Gastric cancer after gastric bypass for obesity. Case report. We describe a patient in whom gastric cancer developed after gastric bypass for morbid obesity. In addition, we review the literature to emphasize the technical problems involved in diagnosing disease in the excluded portion of the stomach.
Depressed adenoma of the stomach. Conceptual review and study of five cases. Depressed gastric adenoma is a recently featured lesion, distinguished by a depression in the gastric mucosa, with histologic changes of conventional adenomatous polyp. We observed five cases of depressed gastric adenoma, one of them associated with a peptic ulcer, another with a gastric stump, and yet another with an early gastric carcinoma. None of the cases was detected clinically by radiology or endoscopic study. Endoscopically, this lesion stimulates a peptic ulcer at a re-epithelialization stage or an early carcinoma of the depressed type. Histologically, all the cases showed dysplastic changes of varying degrees, with a relevant risk of malignancy. A similarity is shown to other lesions described in the gastric mucosa.
Maxillofacial considerations in orthotopic liver transplantation. Orthotopic liver transplantation is now a widely used treatment for patients with end-stage liver disease. Lifelong pharmacologic immunosuppression renders these patients susceptible to many infections. The purpose of this article is to provide guidelines for treating the patient with end-stage liver disease, both before and after transplantation. In addition, we shall discuss some of the medical implications associated with end-stage liver disease and their clinical presentations and appropriate presurgical management. Adverse side effects of long-term immunosuppression and their effect on the oral and maxillofacial region shall also be discussed. Last, a brief discussion of FK506, the latest immunosuppressant, will be presented together with the implications of its use on our surgical treatment of these patients.
Prevalence of asthma among 12 year old children in New Zealand and South Wales: a comparative survey. A survey of 12 year old schoolchildren was carried out in New Zealand and South Wales, the same questionnaire and exercise provocation test being used. The prevalence of a history of asthma at any time was higher in New Zealand (147/873, 17%) than in South Wales (116/965, 12%). The New Zealand children were also more likely than the Welsh children to have a history of "wheeze ever" (27% versus 22%), and wheeze brought on by running (15% versus 10.5%). The sex ratio of asthmatic and wheezy children was very similar in the two countries. A history of hospital admission for chest trouble was twice as common in New Zealand as in South Wales. An exercise test produced a fall in peak expiratory flow rate of 15% or more in more New Zealand children (12.2%) than Welsh children (7.7%). These results suggest that the prevalence of childhood asthma is higher in New Zealand than in South Wales.
The management of transitional cell carcinoma in solitary renal units. Ten patients with urothelial malignancies involving a solitary functioning renal unit were treated at our center for an average of 24 months or until death. These patients were all managed by parenchyma-sparing methods, including percutaneous as well as ureteroscopic tumor resection. Of our patients 9 have received adjunctive chemotherapy in the form of bacillus Calmette-Guerin instillations. At the time of this report 5 of our patients were alive without evidence of disease, 4 were alive with evidence of either residual or recurrent neoplasia and 1 was dead of disease 5 years after original presentation. Patients with higher grade tumors or carcinoma in situ did less well than patients with low grade disease. We present an analysis of our experience with this complex patient population and discuss the implications of these data within the context of a growing literature on the topic of upper tract urothelial malignancy.
Restenosis after coronary angioplasty: an overview. Despite substantial basic and clinical efforts to address the problem of restenosis after percutaneous coronary intervention, effective preventive therapies have not yet been developed. Nevertheless, the accumulated information has provided much insight into the process of restenosis in addition to allowing standards to be developed for adequate clinical trials. The pathophysiology of restenosis increasingly appears to be distinct from that of primary atherosclerosis. Restenosis involves elastic recoil, incorporation of thrombus into the lesion and fibrocellular proliferation in varying degrees in different patients. Lack of an animal model that satisfactorily mimics restenosis is a major impediment to further understanding of the process. Clinical studies are hampered by difficulties in finding a single unifying definition of restenosis and by variable methods of reporting follow-up. Reporting of clinical outcomes of all patients in angiographic substudies would allow a more satisfactory interpretation of the results of clinical trials. Current noninvasive test results are not accurate enough to substitute for angiographic and clinical outcome data in intervention trials. In the majority of observational studies, only diabetes and unstable angina have emerged as consistently associated with restenosis; whereas most of the standard risk factors for atherosclerosis have a less consistent relation. Disappointingly, the new atherectomy and laser technologies have not affected restenosis rates. The one possible exception is coronary stenting, as a result of the larger luminal diameter achieved by the placement of the stent. In conclusion, although substantial continued effort is necessary to explore the basic aspects of cellular proliferation and mechanical alteration of atherosclerotic vessels, attention to the principles of clinical trials and observation are required to detect the impact of risk factors and interventions on the multifactorial problem of restenosis. Adequate sample sizes, collection of clinical and angiographic outcomes and factorial study designs hold promise for unraveling this important limitation of percutaneous intervention.
Crescentic glomerulonephritis in Wegener's granulomatosis: morphology, therapy, outcome. Fourteen patients with Wegener's granulomatosis (WG) and severe renal and extrarenal involvement were studied (serum creatinine on admission 5.8 +/- 3.4 mg/dl). Renal histology showed a necrotizing, crescentic glomerulonephritis in all patients. Despite advanced renal disease on admission cyclophosphamide, steroids (in 13 patients) and plasma exchange (in 9 patients) caused a rapid and sustained improvement of renal function. Four patients required intermittent hemodialysis over a period of one week. After 2 weeks of treatment serum creatinine values below 2 mg/dl (n = 4) indicated a nearly complete recovery of renal function in the long-term follow up (mean serum creatinine achieved after 12 months therapy: 1.1 +/- 0.1 mg/dl (n = 4). Therefore serum creatinine values observed after 2 weeks of therapy, appear to be of prognostic value with regard to renal outcome. No relapse of active WG or progressive renal deterioration was observed during follow-up (22 +/- 13 months) except in one patient with persisting renal impairment. Three patients died (staphylococcus sepsis, intracerebral hemorrhage during hypertensive crisis, pulmonary embolism) during the first two months of therapy. The decline of serum creatinine seemed to be a better indicator of successful therapy than the decrease of anticytoplasmatic antibody (ANCA), erythrocyte sedimentation rate (ESR) and hematuria. On admission ANCA titer neither correlated with serum creatinine, the degree of renal involvement, nor was it of prognostic value. ANCA, serum creatinine and hematuria normalized within 2 to 8 months, whereas ESR and proteinuria remained elevated. Our data indicate a good prognosis of WG even with advanced renal involvement and generalized vasculitis provided aggressive treatment is performed early.
The Istituto Rizzoli-Beretta experience with osteosarcoma of the jaw. Twenty-eight osteosarcomas (OS) of the jaw were reported. There were 15 male and 13 female patients (age range, 9 to 68 years; mean, 36.9 years); 57.1% of the patients were older than 30 years of age. Swelling was the most frequent symptom; it was reported on an average of 6 months before diagnosis. Most of the tumors of the maxilla (eight patients) occurred in the alveolar ridge (six of eight). In the mandible (20 patients), the body was the preferred site (11 of 20). Radiographically most of the lesions were either lytic and sclerotic or only lytic. Histologically, 12 cases (42.9%) were osteoblastic osteosarcoma, ten (35.8%) were chondroblastic, four (14.3%) were fibroblastic, and two (7%) were round cell OS. Of the 28 cases, three (10.7%) were low grade, and 25 (89.3%) were high grade. Thirteen patients had intralesional surgery, and 13 had marginal surgery as their initial treatment. Recurrence was the rule in the first group, and it was 69% in the second group. Twenty patients (71%) died, and eight are alive. Of these, two are alive with disease. In the six patients who are alive and disease-free, all but one had marginal to wide surgical margins at the time of the first procedure or wide margins at the time of the recurrences along with chemotherapy or radiation therapy. In the patient in which the surgical margins were marginal, the lesion was small 2.5 X 2 cm. This patient was alive without evidence of disease after 9 years of follow-up.
Accuracy of a mixed venous saturation catheter during acutely induced changes in hematocrit in humans. OBJECTIVE: To determine the accuracy of in vivo mixed venous hemoglobin saturation (Svo2) measurements with a fiber optic thermodilution catheter during acute changes in hematocrit. DESIGN: Comparison of fiberoptic in vivo Svo2 values with in vitro Svo2 values obtained with a multiwavelength spectrophotometer. SETTING: Operating room in a university hospital. PATIENTS: Six consecutive patients who are Jehovah's Witnesses. MEASUREMENTS AND MAIN RESULTS: Before and after each step of hypervolemic hemodilution and after every 500 mL of blood loss, blood gases were analyzed and hemodynamic, hemoglobin, hematocrit, and in vitro and in vivo Svo2 measurements were made. Hematocrit values were measured in the range of 40% to 18%. Plotting all in vivo Svo2 values (n = 74) against the in vitro Svo2 measurements obtained during the entire study period gives r2 = .86. The accuracy of in vivo Svo2 measurements was not affected by changes in hematocrit or cardiac output. The Svo2 catheter value at the beginning of the study differed from the in vitro Svo2 value by -0.86 +/- 2.56% and at the end of the study period of 8 to 10 hrs by 0.71 +/- 3.04%. CONCLUSIONS: The accuracy of the studied fiberoptic continuous measuring Svo2 system was not affected by changes in hematocrit or cardiac output. No significant drift in the in vitro Svo2 measurements was observed.
Normal P300 following extensive damage to the left medial temporal lobe. Event-related potentials (ERPs) were recorded during auditory and visual "oddball" tasks from a patient with a severe verbal memory deficit due to a low grade infiltrating glioma which involved the full extent of the left medial temporal lobe. In both sensory modalities, the patient's oddball-evoked P300s were symmetrical and of normal amplitude. These findings are difficult to reconcile with the hypothesis that the hippocampus, or any other medial temporal structure, makes a substantial contribution to the scalp P300.
Multicentric osteolysis: an infrequently recognized renal-rheumatologic syndrome. We describe the case of a young girl with Type III multicentric osteolysis, a rare syndrome characterized by osteolysis and renal insufficiency. Our report is intended to make physicians aware of this uncommon cause of renal and rheumatologic abnormalities.
Management of low-grade cervical dysplasia during pregnancy. Fifty-five pregnant patients referred to my colposcopy service from 1985 to 1990 for biopsy-proven mild dysplasia were entered into a program of serial evaluations, including Pap test, colposcopy, and directed biopsy if indicated. The evaluations were done every 12 weeks during pregnancy and at 6 weeks postpartum to rule out new or occult invasive cervical cancer. By the time the postpartum biopsy was done, no such cancer had been detected. All 55 patients had mild dysplasia or less. I conclude that pregnant patients with biopsy-proven mild cervical dysplasia who have had adequate expert colposcopy and results of Pap test consistent with biopsy require only one antepartum colposcopy prior to postpartum reevaluation and treatment. Multiple interval cytologic and colposcopic studies with or without biopsy are unnecessary. The likelihood of invasive cervical cancer developing in these patients during pregnancy is negligible.
Transcortical aphasia. Importance of the nonspeech dominant hemisphere in language repetition. While a relative preservation of repetition in acute transcortical aphasia (TA) has usually been associated with the functional integrity of the speech dominant (left) perisylvian area, recent amytal data (Bando et al., 1986) have suggested a fundamental role of the nondominant (right) hemisphere in language repetition. The neuroradiological correlates of repetition were studied in a consecutive series of 21 patients with acute TA. A similar frequency of either perisylvian or extraperisylvian pathology was found. In 2 patients with perisylvian pathology, the injection of amytal in the hemisphere contralateral to the lesion abolished repetition. Positron emission tomography (PET) in another patient revealed marked hypometabolism over the entire left cortical mantle ipsilateral to a basal ganglia lesion, suggesting that preserved repetition was carried out by right hemisphere structures. This was confirmed in a second patient with left extraperisylvian pathology, in whom a second lesion in the right hemisphere resulted in impaired repetition. These findings suggest that the spared contralateral hemisphere may subserve residual repetition in some transcortical aphasic patients with a lesion within or outside the speech-dominant perisylvian area.
Retinal detachment adherent to posterior chamber IOL after Molteno implant surgery. A patient with refractory glaucoma 1 year after cataract extraction and trabeculectomy had Molteno implant surgery. Three days after surgery a kissing choroidal effusion and retinal detachment adherent to the posterior chamber IOL were detected. Repeated choroidal taps were unsuccessful. Removal of the Molteno implant, vitrectomy, and silicone oil injection were required to reattach the retina.
Impairment of natural killer functions by interleukin 6 increases lymphoblastoid cell tumorigenicity in athymic mice. Expression of the human IL-6 gene in EBV-immortalized normal human B lymphocytes following retroviral-mediated transduction rendered these cells highly tumorigenic in athymic mice. The tumors were lymphomas composed of the originally inoculated human lymphoblastoid cells. Co-injection of IL-6 expressing EBV-immortalized cells with IL-6 nonexpressing control cells resulted in increased tumorigenicity of the IL-6 nonexpressing cells. The lymphoblastoid cells expressing IL-6 were indistinguishable from parental cell lines in morphology and in a variety of cell surface characteristics, and did not exhibit growth advantage over parental cell lines in vitro, such that increased tumorigenicity is unlikely to depend upon a direct oncogenic effect of IL-6 on the B cells. Rather, at high concentrations, IL-6 markedly inhibits human lymphoblastoid cell killing by IL-2-activated murine splenocytes in vitro, suggesting that IL-6-related tumorigenicity might depend upon IL-6 inhibiting cytotoxicity at the tumor site. Thus, production of IL-6 by tumor cells that results in natural killer cell dysfunctions illustrates a novel mechanism of tumor cell escape from immune surveillance.
Racial differences in HLA antigen frequency and hypertensive renal failure. Black patients with hypertension are six times more likely to develop end-stage renal disease than are their white counterparts. To determine if genetic differences associated with the Human Leukocyte Antigen (HLA) system account for racial variation in hypertensive renal failure, we examined antigenic frequencies from a large renal transplant registry. Human Leukocyte Antigen phenotypes from cadaveric renal transplant recipients and donors in the South Eastern Organ Procurement Foundation database from 1982 to 1986 were analyzed. One thousand six hundred four renal transplant recipients with hypertensive renal failure as the cause of end stage renal disease (cases) were compared with 4506 race-matched cadaveric kidney donors (controls). Log-linear models were used to assess the relationship between hypertensive renal failure and prevalence of each HLA phenotype. Bonferroni adjustments of P values were used to correct for multiple comparisons. Comparison of HLA frequencies between blacks and whites with hypertensive renal failure demonstrated that blacks had an increased frequency of HLA-DR3 beyond that normally known to exist between black and white populations. Black cases compared to black controls had an 8.6% increase in HLA-DR3 frequency contrasted with a 1.6% decrease in the frequency of this antigen between white cases and white controls. This absolute 10.2% difference between the races was significant (P = .02) because the control black and white populations had nearly identical frequencies for this antigen. White cases compared to white controls had lower HLA-A1 and B8 frequencies (21.2% v 30.6%, P = .0005 and 13.7% v 22.3%, P = .001, respectively) and a greater HLA-B35 frequency (20.7% v 14.2%, P = .02).
Later recurrence and longer survival among obese patients with renal cell carcinoma. To investigate the effect of obesity at diagnosis on prognosis of renal cell carcinoma, 360 renal cell carcinoma patients newly diagnosed at 29 hospitals in Oklahoma between January 1, 1981 and December 31, 1984 were followed through December 31, 1987. The Cox proportional-hazard model was used to estimate the hazard ratio, adjusting for other potentially prognostic factors. Both the disease-free interval and the overall survival were longer in patients who were obese (greater than or equal to 120% standard body mass index) at diagnosis. The adjusted-hazard ratio for disease recurrence between obese and nonobese patients was 0.43 (95% confidence interval [CI], 0.19 to 0.98). The obese patients had an adjusted death hazard rate 0.68 times that of the nonobese patients (95% CI, 0.38 to 1.22). Although obesity was reported to increase the risk for renal cell carcinoma, prognosis was no worse and may be better among obese patients with the disease.
Node negative breast cancer: the prognostic value of DNA ploidy for long-term survival. The DNA content of breast tumours from 170 patients who presented between 1978 and 1980 was measured by flow cytometry. The relationship between tumour ploidy and disease outcome was assessed and its association with other prognostic factors evaluated. Compared with those with diploid tumours, patients with aneuploid tumours had significantly earlier relapse and shorter survival (P less than 0.0001). Tumour ploidy was strongly related to grade (P less than 0.001), but there was no significant association between DNA ploidy and c-erb-B-2 expression, lymph node status or tumour size. In lymph node negative and c-erb-B-2 negative patients, aneuploid tumours were associated with a poorer prognosis (P less than 0.001) than diploid tumours. Multivariate analysis showed that tumour ploidy gave independent information on disease free and overall survival. Tumour ploidy may be used as an independent prognostic variable in patients with breast cancer and it may be helpful in defining patients within the node negative or c-erb-B-2 negative groups likely to have a poor outcome who might benefit from adjuvant treatment.
Effect of angiotensin converting enzyme inhibition on the incidence of restenosis after percutaneous transluminal coronary angioplasty. To determine whether angiotensin converting enzyme (ACE) inhibition may reduce the incidence of restenosis after percutaneous transluminal coronary angioplasty (PTCA), we retrospectively identified 322 consecutive patients who underwent a successful procedure from June 1988 to December 1989. No patients developed chest pain, ST segment elevation, positive cardiac enzymes, or other evidence of abrupt vessel closure following the PTCA. All patients received intravenous heparin after PTCA and aspirin was begun on the day prior to PTCA. Patients were separated into two groups: those at hospital discharge incidentally treated for hypertension or heart failure with ACE inhibitors (n = 36), and those treated with a drug regimen which did not include ACE inhibitors (n = 286). The two groups were similar with respect to age (61 +/- 13.5 vs. 60 +/- 12.5, p = NS) and other demographic characteristics. Restenosis, defined as the presentation to a physician with symptoms of angina within 6 months of the PTCA and the finding on repeat catheterization of a significant restenosis at the site of the PTCA, occurred in 30% of the patients who were discharged on a drug regimen which did not include ACE inhibitors vs. 3% (p less than .05) in those treated with an ACE inhibitor. Thus, it appears that the use of ACE inhibitors may significantly reduce the incidence of restenosis after successful PTCA.