shukoor65/lab-rag-model huggingface dataset:
National High Blood Pressure Education Program Working Group report on ambulatory blood pressure monitoring. Blood pressure measurements obtained in a physician's office may not represent a patient's blood pressure during an entire day. Ambulatory blood pressure monitoring (ABPM) provides multiple readings over time. This review of the literature on ABPM addresses the current state of ABPM methods, normal blood pressure profiles, the clinical and research uses of ABPM, cost considerations, and recommendations for use of ABPM in selected circumstances. Current ABPM devices use either auscultatory or oscillometric methods to determine blood pressure. A rigorous comparison of these methods is needed to determine whether one method is more reliable. A nonbiased assessment of all available equipment is necessary. Normative data provided by ABPM research are needed for populations by age, race, gender, body habitus, and conditions, such as pregnancy. While ABPM is not cost-effective for all hypertensive patients, it can assist in the evaluation of such problems as target organ complications, syncopal episodes, episodic hypertension, and autonomic dysfunction.
Reversible hypertriiodothyroninaemia due to adrenal insufficiency. It is well known that an excess of glucocorticoids affects thyroid tests. The effect of adrenal deficiency on thyroid hormones is less well defined. We here describe the case of a 33-year-old woman with Cushing's disease who was cured by trans-sphenoidal surgery. During the postoperative period, a secondary adrenal insufficiency developed. The thyroid blood tests then revealed elevated L-triiodothyronine (T3) levels and a decrease in reverse T3. These findings suggest that secondary adrenal deficiency may be associated with high T3 levels, which may be due to an increase in the peripheral conversion of thyroxine (T4) to T3.
Survival and vehicular spread of human rotaviruses: possible relation to seasonality of outbreaks. In developing countries rotavirus infections account for nearly 6% of all diarrheal episodes and for 20% of diarrhea-associated deaths of young children. Even in industrialized countries rotavirus diarrhea in the young is among the leading causes of hospitalization. In temperate regions institutional outbreaks of the disease occur mainly in cold dry weather, whereas in tropical settings the seasonality is less well defined. Waterborne outbreaks of rotavirus gastroenteritis have been recorded; air, hands, fomities, and food may also act as vehicles for this infection. Rotaviruses can survive for weeks in potable and recreational waters and for at least 4 hours on human hands. In air and on nonporous inanimate surfaces, the survival of rotaviruses is favored by a relative humidity of less than or equal to 50% and viral infectivity can be retained for several days. Rotaviruses are relatively resistant to commonly used hard-surface disinfectants and hygienic hand-wash agents.
Stress hormone and blood glucose response following acute stroke in the elderly. We studied the relation of reactive hyperglycemia, stress hormone response, and outcome in 23 consecutive elderly patients (median age 80 [range 75-92] years) following an acute first stroke. The median delay from the onset of the stroke to the first blood sample (day 0) was 9 (range 4-22) hours. Subsequent blood samples were taken, after fasting, for the determination of blood glucose, cortisol, catecholamine, insulin, C-peptide, glucagon, and lactate concentrations on days 1, 2, 3, 7, 14, 30, and 90. For all 23 patients, a significant relation was found between the blood glucose concentration and survival (p = 0.03) and the blood glucose concentration decreased with time (p less than 0.001). There was also a significant relation between blood glucose concentration and outcome (p = 0.02). For the 15 patients with complete data, the major determinants of the blood glucose concentration were the cortisol, insulin, and glucagon concentrations (all p less than 0.001), which accounted for 42% of the variance. When all the indexes were analyzed together by logistic regression, only the cortisol concentration was related to outcome (p = 0.02). Hyperglycemia following a stroke probably reflects the intensity of the stress hormone response. We have confirmed that hyperglycemia is a predictor of outcome in persons with stroke.
The 72-hour examination as a predictor of recovery in motor complete quadriplegia. Twenty-nine C4 to C7 motor-complete spinal cord injured subjects were evaluated to determine whether the manual muscle test (MMT) performed within 24 hours of injury or at 72 hours after injury better predicts short-term functional muscle recovery. A single muscle in the zone of injury that had a muscle grade between 1 and 3, inclusive, was evaluated serially in each patient from admission to three months. Increase in muscle strength to grade 4 or better was defined as success. Outcomes were evaluated by the Fisher exact test. Using the less-than-24-hour MMT, 12 of 17 subjects with grade 3 muscle strength vs four of 12 subjects with grade 1 or 2 muscle strength achieved success (p greater than .05). Using the 72-hour MMT, all 11 subjects with grade 3 muscle strength vs five of the 18 subjects with less than grade 3 muscle strength achieved success (p less than .001). Short-term functional muscle recovery in the zone of injury in cervical motor-complete quadriplegia is better predicted by the 72-hour MMT than by the less-than-24-hour MMT.
Effects of recombinant human tumor necrosis factor on rodent gliomas and normal brain. In a study examining the possible therapeutic effects of recombinant human tumor necrosis factor-alpha (rHuTNF-alpha) on malignant gliomas without expression of tumor necrosis factor (TNF)-receptors, RG-2 glioma cells were tested in vitro as well as in a rat experimental glioma model. A growth inhibition assay revealed no inhibiting effect in vitro up to a concentration of 20 micrograms/ml rHuTNF-alpha. Receptor-binding studies showed that RG-2 cells did not present specific receptors for rHuTNF-alpha. The pharmacokinetics of rHuTNF-alpha after intravenous injection were studied with respect to serum, tissue, and brain tumor concentrations and showed increased glioma concentrations of (mean +/- standard error of the mean) 0.47 +/- 0.18 ng TNF/mg brain compared to 0.15 +/- 0.05 ng TNF/mg brain in the normal contralateral hemisphere. No therapeutic effect on solid RG-2 gliomas could be observed after stereotactic injection of 7.3 micrograms rHuTNF/10 microliter buffer solution into the tumor in 10 animals. Immunohistochemical studies after stereotactic injection of rHuTNF-alpha showed total disappearance of the substance after 24 hours without internalization into tumor cells. Stereotactic injection of 7.3 micrograms rHuTNF 10 microliters into normal brain resulted in marked inflammatory response around the injection track, including microvascular thrombosis. These results demonstrate that rHuTNF has neither direct nor indirect cytotoxic activity on RG-2 glioma cells. Furthermore, before clinical use of rHuTNF-alpha in malignant gliomas, the authors suggest that receptor studies be done in each patient. In receptor-positive patients undergoing treatment with rHuTNF-alpha, precautions should be taken to prevent local encephalitic reactions.
In vitro activities of acridone alkaloids against Pneumocystis carinii. Acridone alkaloids isolated from plants of the family Rutaceae have antiplasmodial activity in rodent models of malaria. Because a variety of antimalarial agents have also been shown to have activity against Pneumocystis carinii, we tested six of these alkaloids in an established culture model for P. carinii. Atalaphillinine and glycobismine A inhibited growth of cultured P. carinii at concentrations of 2.7 and 1.7 microM, respectively. This potency of effect is similar to that of chloroquine (3 microM) but somewhat less than that of primaquine (0.4 microM), which was previously evaluated in the same system.
Survivorship analysis and confidence intervals. An assessment with reference to the Stanmore total knee replacement. Survivorship analysis is a useful way of expressing the long-term results of joint replacement: it provides a means of comparing the life span of one type of prosthesis with another. However, such studies should include a full life-table and the confidence intervals for the survival rates at given times. At least 40 surviving prostheses are required to provide reliable results.
Pediatric heart transplantation for congenital heart disease and cardiomyopathy. Orthotopic heart transplantation has become an accepted therapy for adult patients with end-stage heart disease. In newborns and infants, this procedure is still controversial because of the unknown long-term results and the lack of donor organs. Since March 1988, we have performed orthotopic heart transplantation in 11 infants and children with hypoplastic left heart syndrome (n = 6), cardiomyopathy (n = 4), or congenital endocardial fibroelastosis (n = 1). The smallest infant was 3 days old and weighed 2,650 g. Four of 15 potential donors had to be refused for various medical reasons, and 4 were transferred to our hospital for organ retrieval. Seven hearts were procured remotely. We accepted weight mismatches up to 105% between donor and recipient. There were three perioperative deaths, two in patients 5 and 17 days old with hypoplastic left heart syndrome and 1 in a 2-year-old patient with a dilated cardiomyopathy. All 3 patients had drug-resistant right heart failure. A 2-year-old girl with a dilated cardiomyopathy died 2 months after transplantation owing to severe pulmonary embolism originating from the superior vena cava. The remaining 7 patients are alive and well between 1 month and 31 months after transplantation. Angiographic follow-up has not revealed signs of graft atherosclerosis at 2 years.
Metastatic basal cell carcinoma: report of twelve cases with a review of the literature. Metastatic basal cell carcinoma was found in 12 patients at the University of Wisconsin Mohs Surgery Clinic during the period 1936 to 1989. All patients were white men. The time of onset of the primary tumor ranged from childhood to 71 years. Eleven patients had previous treatment for basal cell carcinoma; two patients had received x-ray radiation to the face for teenage acne. The locations of the primary basal cell carcinomas were the face (n = 10), back (n = 1), and arm (n = 1). The primary tumors ranged from 3.6 x 3.0 to 20.0 x 7.0 cm. The interval from onset to the first sign of metastases ranged from 7 to 34 years. In all cases, the primary tumor was histologically identical to the metastatic lesion. Perineural extension of the basal cell carcinoma in the primary lesion was found in five cases. Regional lymph nodes were the most frequent site of metastasis. Treatment consisted of a combination of surgery, radiation, and chemotherapy. Only two patients survived more than 5 years after surgical treatment. One patient has survived 25 years and is still alive.
Complete external iliac artery disruption after percutaneous aortic valvuloplasty in two young children: successful repair with hypogastric artery transposition. The majority of vascular injuries in young children are iatrogenic. This is a report of two complete external iliac artery disruptions occurring during percutaneous transfemoral balloon aortic valvuloplasty in a 2-year-old and a 5-year-old child. The damaged external iliac artery was bypassed by extensively mobilizing the hypogastric surgery and rotating it upward to anastomose it to the proximal common femoral artery. Normal limb pulses, function, and growth were noted in follow-up.
Embolization of cardiac myxomas masquerading as polyarteritis nodosa. Cardiac myxomas are rare tumors which can mimic other diseases. We describe a 19-year-old man who presented clinically with polyarteritis nodosa (PAN). Muscle biopsy showed vasculitis, but corticosteroid and immunosuppressive therapy was initially effective. Cardiac myxomas were found by echocardiogram when the disease relapsed and were resected surgically. Segmental arterial aneurysms and stenoses were found on angiography after leg ischemia. We suggest that echocardiography should be performed in all cases of clinically suspected PAN.
Acute bronchitis in children: building a clinical definition. Much about acute bronchitis in children is uncertain, even its definition. This study was undertaken to help build a clinical definition to serve as a guide for further research. Charts of 180 children 1 to 12 years old were reviewed. Each had received a diagnosis of acute bronchitis (54 patients), upper respiratory infection with a cough (128 patients), or a new diagnosis of asthma (26 patients) during the previous 12 months. A history of sputum production (odds ration 25.0, p = 0.0001), the finding of rales or rhonchi on examination (OR 11.6, p less than 0.0001), and a past history of lower respiratory illness (OR 3.0, p = 0.01) were associated with a diagnosis of acute bronchitis, but fever and duration of illness were not. In addition, the diagnosis of acute bronchitis was strongly associated with a prescription for an antibiotic. In a child with a cough, acute bronchitis is more likely to be diagnosed if there is a history of sputum production, rales or rhonchi on examination, and a past history of lower respiratory disease.
Shock wave lithotripsy of gallstones: results and 12-month follow-up in 174 patients. At the authors' institution, as part of the on-going Dornier National Biliary Lithotripsy Study, 174 patients with gallstones were randomly assigned to receive either ursodeoxycholic acid (UDCA) or placebo for 6 months after undergoing extracorporeal shock wave lithotripsy (ESWL). Six weeks after ESWL, 40 (23%) patients were re-treated for gallstone fragments larger than 5 mm in diameter. No significant difference in the UDCA- and placebo-treated patients was noted. The overall 6- and 12-month stone-free rates for all patients with initially noncalcified stones were as follows: UDCA patients, 31% and 36%, respectively, and placebo patients, 21% and 23%, respectively (P less than .05). In patients with a single, noncalcified gallstone that was at most 20 mm in diameter, the 12-month stone-free rates were as follows: UDCA patients, 60%, and placebo patients, 33% (P less than .01). Patients with noncalcified stones that were 11-20 mm in diameter who were treated with UDCA had a higher rate of stone clearance than placebo patients. At 6 months, the authors' previous study demonstrated no significant difference in the two groups of patients. However, the stone-free rate at 12 months was noted to be significantly higher for patients with a single, noncalcified stone that was at most 20 mm in diameter begun on UDCA than for all other groups of patients.
In vivo thrombin inhibition enhances and sustains arterial recanalization with recombinant tissue-type plasminogen activator. The effects of heparin and the synthetic competitive thrombin inhibitor (2R,4R)-4-methyl-1-[N2-(3-methyl-1,2,3,4-tetrahydro-8-quinolinesulfon yl)-L-arginyl]-2-piperidinecarboxylic acid monohydrate (Argatroban) on thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) was studied in groups of six or seven rabbits with arterial thrombosis. The model consisted of a whole-blood clot produced in a 1-cm isolated femoral arterial segment with superimposed endothelial damage and distal high-grade stenosis. rt-PA was injected as an intravenous bolus of 0.45 mg/kg body wt at 15-minute intervals until recanalization, or up to a maximum of four boluses. In seven rabbits given an intravenous injection of 17 mg/kg aspirin, rt-PA induced transient reflow in only one animal. In seven rabbits that received intravenous heparin (200 units/kg over 60 minutes), rt-PA administration produced reflow in five animals, which was persistent in two rabbits. Combined administration of aspirin and heparin in seven rabbits was associated with similar rt-PA-induced recanalization. rt-PA administration in six rabbits given intravenous Argatroban (100 micrograms/kg/min for 60 minutes) caused recanalization in five, with persistent patency in three. In six rabbits given aspirin and Argatroban, rt-PA caused recanalization in all, with persistent patency in five animals. Reflow occurred significantly more rapidly with Argatroban (14 +/- 7 minutes) than with heparin (35 +/- 11 minutes), reflow was obtained with fewer boluses of rt-PA in combination with Argatroban (median value of one bolus) than with heparin (median value, three boluses), and reocclusion after reflow was less frequent with Argatroban (0 of 11 versus 5 of 10 rabbits). Furthermore, the degree of thrombolysis determined by pathological analysis was significantly more extensive with Argatroban than with heparin, and patency persisted during a 3-hour observation period, despite elimination of Argatroban from the circulation. Thus, Argatroban, relative to heparin, enhances and sustains thrombolysis with rt-PA. It may offer promise as an adjunctive agent for thrombolytic therapy of arterial thrombosis.
The use of color flow mapping for intraoperative assessment of valve repair. Repair procedures that preserve a patient's native valve are associated with a lower perioperative and late mortality, a lower incidence of thromboembolic events, and better preservation of left ventricular function than prosthetic replacement. Traditionally employed procedures for intraoperative assessment of the adequacy of repair, such as fluid injection into the arrested ventricle for assessment of valve leakage, measurement of atrial pressure and height of V-waves, and palpation of the atria for the presence of systolic thrills, have not proved to be reliable approaches in the intraoperative evaluation of mitral and tricuspid regurgitation and in the assessment of the adequacy of repair procedures. Intraoperative color Doppler, using either the epicardial or the transesophageal approach, offers rapid and accurate information about the presence and severity of mitral regurgitation at the time of surgery. This technique provides instantaneous evaluation of the adequacy of mitral and tricuspid valvuloplasty and appears capable of predicting postoperative outcome. Intraoperative color Doppler is useful for evaluation of the adequacy of repair before chest closure and may thus help to avoid the need for reoperation. This approach may ultimately allow valve repair procedures to be performed in greater numbers of patients with better control over outcome and with lower reoperation rates.
Histological diagnosis of intestinal microsporidiosis in patients with AIDS. Fifty nine patients seropositive for human immunodeficiency virus (HIV) and diarrhoea and 20 with weight loss were investigated for microsporidiosis using light and electron microscopical examination of duodenal and jejunal biopsy specimens. Eight cases of microsporidiosis were found, in five of whom it was the sole pathogen. In all eight cases the organism was identified at light microscopy without prior knowledge of the electron microscopical findings. All stages of the life cycle are best seen in resin sections cut at 1 micron and stained with Giemsa, but spores could easily be identified in paraffin sections cut at 5 microns and stained with haematoxylin and eosin. In all cases the parasite was identified both in duodenal pinch and jejunal "Crosby" capsule biopsy specimens. All cases of microsporidiosis occurred in patients with diarrhoea. Both electron and light microscopical examination suggested that the pathogenic mechanism involves the shedding of infected enterocytes containing large numbers of spores. It is suggested that the optimal way to diagnose microsporidiosis is by light microscopical examination of duodenal pinch biopsy specimens.
Fluid distribution and pulmonary dysfunction following burn shock. Respiratory function and body fluid changes were measured in 46 burned patients for up to 7 days postburn (DPB). The patients in this prospective study were divided into an HLS group [n = 17, burn size 61 +/- 0.5% BSA (mean +/- SEM), resuscitated with hypertonic lactated saline] and an iso-Na group (n = 29, burn size 60 +/- 4.5% BSA, resuscitated with lactated Ringer's solution). During DPB 3 to 5, the Respiratory Index (A-aDO2/PaO2), functional extracellular fluid volume (f-ECFV), an ratio of plasma volume to interstitial fluid volume (PV/ISFV) were increased in the iso-Na group compared with the HLS group. During the same period, the Respiratory Index and PV/ISFV correlated significantly; respiratory dysfunction was less in the HLS group. Nearly 50% of the iso-Na group required endotracheal intubation. Sodium loads were the same in both groups; the HLS group required less water. These results suggest that extracellular fluid distribution differs between the two treatments; HLS may be associated with ameliorated respiratory function not only because of less volume loading during resuscitation, but also because the PV/ISFV ratio is less than when lactated Ringer's is administered.
Carotid baroreceptor function in dogs with chronic norepinephrine infusion. Carotid baroreceptor function, the compliance of the carotid sinus wall, and the structure of the carotid artery were examined in dogs with elevated plasma norepinephrine (2,000-4,000 pg/ml) for 28 days. The dogs with high norepinephrine were normotensive (100 +/- 4.0 versus 98 +/- 4.0 mm Hg; p greater than 0.05) with bradycardia (65 +/- 4.0 versus 87 +/- 16 beats/min; p less than 0.05) compared with normal dogs in the conscious state. However, after pentobarbital anesthesia blood pressure was significantly higher in dogs with chronic norepinephrine infusion (165 +/- 6 mm Hg) compared with normal dogs (132 +/- 6 mm Hg). To assess baroreceptor sensitivity, multiunit carotid baroreceptor activity was recorded from the right carotid sinus nerve, and the carotid sinus wall compliance (sonomicrometers) was measured during nitroglycerin and phenylephrine injections. The threshold and saturation pressures increased from 96 +/- 3.9 to 117 +/- 4.2 mm Hg and from 145 +/- 4.3 to 171 +/- 5.7 mm Hg, respectively, in the normal dogs compared with the high norepinephrine dogs. The most striking differences were the marked increases in sensitivity of carotid baroreceptors (0.47 +/- 0.05 versus 1.99 +/- 0.45 spikes.sec-1.mm Hg-1; p less than 0.01) and maximum firing frequency of the baroreceptors (24 +/- 3.1 versus 48 +/- 4.4 spikes/sec; p less than 0.01), whereas the carotid sinus wall compliance was unchanged (0.014 +/- 0.003 versus 0.012 +/- 0.002 mm/mm Hg; p greater than 0.05). Similar alterations were observed using single fiber recordings, that is, an increase in threshold and saturation pressures and slope of baroreceptor units in dogs with elevated norepinephrine. The wall thickness and area of the carotid artery were determined. Both increased significantly (0.77 +/- 0.06 versus 1.30 +/- 0.12 mm and 9.0 +/- 0.8 versus 11.9 +/- 0.9 mm2; p less than 0.05) in dogs chronically infused with norepinephrine while the dry weight-to-wet weight ratio of left carotid artery tissue also increased from 26.0 +/- 0.73% to 29.0 +/- 0.57%. These studies indicate that 1) one of the possible mechanisms responsible for bradycardia in the conscious dogs with high norepinephrine is enhanced sensitivity of carotid baroreceptors; 2) the enhanced sensitivity of carotid baroreceptors is not due to a change in compliance of the carotid sinus wall; and 3) chronic elevation of norepinephrine causes hypertrophy or hyperplasia of the wall of the common carotid artery.