shukoor65/lab-rag-model huggingface dataset:
Evidence for alpha 1-adrenoreceptor hyperresponsiveness in hypotensive cirrhotic patients with ascites. Cirrhosis with ascites is often characterized by arterial hypotension associated with increased plasma norepinephrine levels. Clinical evidence suggests a decreased sensitivity to norepinephrine in this clinical setting, indicating a potential derangement of alpha 1 adrenoreceptors. The aim of the present study was to evaluate the reactivity of the alpha 1-adrenoreceptor, using phenylephrine, a selective alpha 1 receptor agonist. First, we evaluated the pupillar response to the intraconjunctival administration of the agonist. Hypotensive cirrhotic patients showed a trend to a more marked and prolonged response, compared with age-matched healthy controls. Second, we studied the response of alpha 1-adrenoreceptors in the peripheral vasculature by administering iv phenylephrine to a similar group of patients. A significantly greater and longer lasting pressor response was observed in hypotensive cirrhotic patients (p less than 0.0001 vs. healthy controls). Our results indicate that in this group of patients, there is a rather peculiar situation, characterized by alpha 1-adrenoreceptor hyperresponsiveness in the presence of high levels of circulating norepinephrine. This finding could be related to biochemical abnormalities within the peripheral sympathetic nervous system endings.
Superselective embolization of superior gluteal artery pseudoaneurysms following intramuscular injection: case report. Two bleeding superior gluteal artery pseudoaneurysms occurred in a patient with advanced malignant disease following an intramuscular injection. This was diagnosed by angiography and successfully managed by superselective embolization. This avoided further surgery and no additional complication from the pseudoaneurysm occurred up to the time of the patient's demise.
Sternal wound infections and use of internal mammary artery grafts. Previous studies have provided conflicting evidence as to whether an increased risk of mediastinitis is associated with use of the internal mammary artery as a coronary bypass graft. In this study the effects of internal mammary artery grafts on wound complications were analyzed in a prospective, nonrandomized fashion. At New York University Medical Center from January 1985 through May 1988, 2356 patients underwent isolated coronary revascularization. Among these patients 1394 received one or more internal mammary artery grafts (group I) and 962 had vein grafts only (group II). Group I had a mean age of 59.5 years versus 67.7 years in group II; diabetes was equally present in both groups (22.7% versus 24.7%). Operative mortality rate was 1.3% in group I and 5.6% in group II. Sternal infection was significantly more prevalent in group I (2.2%, 31/1394) than in group II (0.8%, 8/962). Multivariate analysis revealed that aortic crossclamp time, use of a single internal mammary artery graft, use of a double mammary graft, and diabetes were associated with increased risk of sternal infection. The use of bilateral internal mammary artery grafting doubled the odds ratio of the risk compared with use of a single mammary graft, and the combination of diabetes and double internal mammary artery grafts increased the odds ratio 13.9-fold. Patients with an internal mammary artery graft who had sternal infection had a longer period of hospitalization than patients without a mammary artery graft who had sternal infection. We conclude that the risk of sternal infection is increased by the use of an internal mammary artery graft, especially use of double mammary grafts in the presence of diabetes.
Socioeconomic status and cancer survival. Survival data from eight Cancer and Leukemia Group B (CALGB) protocols were examined for patients with lung cancer (N = 961), multiple myeloma (N = 577), gastric cancer (N = 231), pancreatic cancer (N = 174), breast cancer (N = 87), and Hodgkin's disease (N = 58). After accounting for differences in survival rate attributable to type of cancer, initial performance status, age, and 14 other protocol-specific prognostic indicators, the additional predictive value of socioeconomic status (SES) was evaluated. Race (white v non-white) was not a significant predictor of survival time, but income and education were. People with lower annual incomes (below $5,000 per year in the years 1977 to 1981) and those with lower educational level (grade school only) showed survival times significantly shorter than those with higher income or education, respectively. These survival differences were associated with, but could not be fully explained by, severity of disease at initial presentation. SES continued to exert a small but significant impact on cancer survival, even after controlling for all known prognostic variables. Economically and educationally disadvantaged cancer patients may require treatment programs that include education about treatment and compliance, even after an initial diagnosis is made and treatment is initiated. Because SES is related to survival independent of all known prognostic variables, it should be included in the data bases of clinical trial groups to provide a more accurate test of the effectiveness of new therapies.
Extracapsular spread of squamous cell carcinoma in neck lymph nodes: prognostic factor of laryngeal cancer. Fifty-two patients with laryngeal cancer who underwent radical neck dissections were studied to provide further information on the prognosis of various clinical and histopathological parameters. Extracapsular spread (ECS) was found in 31% of patients with N1 nodes, and in 60% of patients with histopathologically positive nodes. The 5-year survival rate of histopathological findings was as follows: patients with no pathological evidence of neck metastasis (81%), patients with neck metastasis confined to the lymph node (no ECS) (76%), and patients with ECS (17%). The difference in survival rate between patients with no ECS and patients with ECS was statistically significant (P = .001). Staging classification, T-stage classification, the number of malignant nodes, the diameter of malignant nodes, and combined therapy had no prognostic importance. The most significant factor was the presence of extracapsular spread.
Terazosin: pharmacokinetics and the effect of age and dose on the incidence of adverse events. Terazosin is a new, long-acting, selective, postsynaptic alpha 1-adrenergic receptor antagonist with a chemical structure similar to that of prazosin. In this article the pharmacokinetics of terazosin are reviewed, and the incidence of adverse events in a dose-response study and a meta-analysis of 20 placebo-controlled trials involving a total of 1814 patients is presented. Peak plasma concentrations of terazosin are achieved 1 to 2 hours after oral administration. The relatively long half-life of terazosin (12 hours) enables it to be administered in a once-a-day regimen. Dose and plasma levels of terazosin show a linear relationship. Terazosin is rapidly and completely absorbed after oral administration. The pharmacokinetics of terazosin are not significantly affected by food, age, hypertension, or renal impairment. Adverse events after the administration of terazosin are usually minor and not age related. The incidence of syncope after therapeutic dosages of terazosin is minimal. Terazosin's effectiveness, combined with its pharmacokinetics, safety profile, and potentially favorable lipid effect, makes it a highly appropriate choice for antihypertensive therapy.
Positron emission tomography suggests that the rate of progression of idiopathic parkinsonism is slow. We performed sequential positron emission tomography scans with 6-[18F]fluoro-L-dopa in 9 patients with idiopathic parkinsonism and 7 age-matched normal control subjects to compare changes in the nigrostriatal dopaminergic pathway over time. The mean interval between the scans was 3.3 years for the group with idiopathic parkinsonism and 3.9 years for the control subjects. The scans were analyzed by calculating the ratio of striatal to background radioactivity. Both groups showed statistically significant reductions of striatal uptake over the interval. The rate of decrease was almost identical in each group (p = 0.6). We infer that the usual rate of loss of integrity of the dopaminergic nigrostriatal pathway in patients with idiopathic parkinsonism is slow and the rate of change between the two groups was comparable.
Aggressive peripheral T-cell lymphomas containing Epstein-Barr viral DNA: a clinicopathologic and molecular analysis. The Epstein-Barr virus (EBV) has been shown to be associated with posttransplant lymphoma, Hodgkin's disease, and T-cell lymphoma, in addition to African Burkitt's lymphoma. In a retrospective study of 56 consecutive cases of T-cell lymphoma, EBV DNA was found by Southern blot and in situ DNA hybridization in 10 (20%) of 50 peripheral T-cell lymphomas, but in none of six cases of T-lymphoblastic lymphoma. Peripheral T-cell lymphomas containing EBV DNA could be subclassified into three categories according to histology and immunophenotypic studies: (1) T-cell lymphoma of the helper phenotype, five cases. Two cases had histologic features resembling angioimmunoblastic lymphadenopathy (AILD). (2) T-cell lymphoma of the cytotoxic/suppressor phenotype, four cases. AILD-like features could also be recognized in two cases. Reed-Sternberg-like giant cells were identified in three cases designated Hodgkin-like T-cell lymphoma. (3) Angiocentric T-cell lymphoma or lymphomatoid granulomatosis in one case, initially affecting the skin and nose; no T-cell subset could be defined. Six of the eight EBV DNA-positive patients tested for serum EBV antibodies had elevated titers of IgG antiviral capsid antigen (greater than 640) and/or early antigen (greater than 10). From combined studies of Southern blot hybridization by using EBV termini fragment probe and in situ DNA hybridization, the EBV genomes appeared to be clonotypically proliferated in the neoplastic T cells. The patients in all three groups usually had prolonged fever preceding the diagnosis, hepatosplenomegaly, an aggressive clinical course, and poor response to chemotherapy; nine died with a median survival of only 8 months. We propose that these EBV-associated aggressive T-cell lymphomas, like human T-cell leukemia/lymphoma virus-positive T-cell lymphoma, have characteristic clinicopathologic features and should be treated as a separate disease entity.
Seizures in series: similarities between seizures of the west and Lennox-Gastaut syndromes. We observed seizures resembling infantile spasms in patients with Lennox-Gastaut syndrome (LGS). Infantile spasms, the type of seizures that occurs in patients who have West syndrome, have been well characterized by video-EEG studies and typically occur as a series of sudden generalized flexor or extensor jerks. The seizure types that occur in LGS have not been as clearly delineated. Some patients with West syndrome (WS) in early infancy later develop LGS. Using intensive video-EEG monitoring, we evaluated 14 LGS patients who had seizures that occurred in series. Clinically, the seizures greatly resembled infantile spasms, and the ictal EEG changes were identical to those that occur with infantile spasms. These findings expand the number of features known to be shared by these two syndromes and strengthen the hypothesis that the two syndromes represent age-related manifestations of similar epileptogenic processes.
Natural course of clinically localized prostate adenocarcinoma in men less than 70 years old. A total of 61 patients, less than 70 years old at diagnosis, with clinical stage T1-2, NX, M0, cytologically well or moderately differentiated prostate adenocarcinoma was prospectively included in a surveillance study. Median patient age was 63 years (range 38 to 69 years). Mean followup was 96 +/- 24 months. The probability of local progression to stage T3 disease after 5 and 10 years was 49 and 72%, respectively. The probability of metastases developing after 5 and 10 years was 8 and 23%, respectively. The probability of dying of prostate adenocarcinoma was 2 and 8%, respectively. Moderately differentiated cancer progressed locally significantly faster than well differentiated disease. The relative number of patients who had metastases or died of prostate adenocarcinoma found in our study was comparable to the relative numbers reported after radical prostatectomy and radiation therapy. Therefore, deferred therapy may be an alternative to active therapy in patients with clinically localized prostate adenocarcinoma and with a life expectancy of less than 10 years.
Carcinoid tumors: the relationship between clinical presentation and the extent of disease. In this study the relationship between the initial clinical presentation and the extent of tumor progression was determined in a group of 31 patients with carcinoid tumors. The proportion of patients with symptomatic tumors was similar to those patients with carcinoid tumors that were incidentally found (55% versus 45%; SE = 0.089). Symptoms were caused by metastatic tumor in nine (30%) of the patients and by local effects of the primary tumor in eight (26%) of the patients. The patients with symptoms had a significantly increased frequency of metastatic disease, even when the symptoms were due to the primary tumor, compared to patients with no symptoms (76% versus 7%; p less than 0.001). Tumor size was related to the presence of symptoms and metastases. Symptoms were most common when the size of the primary tumor was greater than 1.0 cm (p less than 0.005), although the rate of metastases increased when primary tumors were 2.0 cm and larger (p less than 0.01). These results indicate that the presence of symptoms or a primary tumor 2.0 cm or larger are associated with an increased risk of metastatic disease in patients with carcinoid tumors. These patients should be treated with wide resection of the primary tumor and its lymphatic drainage.
Colonic volvulus. The Army Medical Center experience 1983-1987. Colonic volvulus was first described in 1836 by von Rokitansky. The condition has been a formidable one, fraught with innumerable complications responsible for many deaths. Even with advances in surgical technology, mortalities have remained high. Often the diagnosis is delayed for hours or even days after presentation, and serious concomitant systemic diseases are often present. Treatment has been controversial, particularly the role of elective resection following successful nonoperative reduction. The Army Medical Center experience with colonic volvulus from 1983 through 1987 is reviewed. Fifty-four patients at the eight medical centers carried this diagnosis. Their presenting signs and symptoms are discussed. The Army patients are compared and contrasted with reviews presented in the surgical literature, and conclusions are made to give guidelines for diagnosis and treatment.
Neuroanatomy and pathophysiology of pain related to spinal disorders. Sensation is achieved through the integration of many neural elements: receptors, afferent and efferent neurons, the spinal cord with its subdivisions, and the higher brain centers. One of the many sensations perceived by the human body is that of pain or nociception. To understand the concept of "back pain" associated with various spinal pathologies, some basic knowledge of the anatomy and physiology of sensation, and more specifically nociception, is necessary. This knowledge is presented herein.
Development of a "Steps Questionnaire". Thousands of men and women have begun their recovery from alcoholism through the support of Alcoholics Anonymous (AA) and its well-known "12-Step" program. The purpose of the present study was to develop a scale to measure alcoholics' levels of agreement with the first three of AA's 12 Steps and to test the relationship between sobriety and belief in these three steps. Using both factor analysis and Rasch analysis, two versions of a "Steps Questionnaire" were developed. A 96-member subset of the original subject pool was assessed quarterly for 1 year following inpatient treatment to determine the predictive validity of the questionnaire. The results of this study suggested that agreement with AA's first three steps can be measured and that agreement with AA's first step correlates with number of sober days posttreatment. The dichotomization of Steps Questionnaire scores into total agreement versus partial agreement with Step 1, and from this the reduction of uncertainty in the prediction of abstention over a lengthy follow-up period, provides support for AA's contention that total surrender to one's powerlessness over alcohol is part of the process of achieving abstention.
Retrospective postmortem dementia assessment. Validation of a new clinical interview to assist neuropathologic study. Neuropathologic studies of dementia and normal aging suffer from a lack of individuals examined for the presence and severity of dementia before death. To increase clinical information in such cases, a retrospective collateral interview was developed. Thirty-nine individuals were studied; 27 had autopsies. In all cases, the autopsy confirmed the Retrospective Collateral Dementia Interview (RCDI) diagnosis of the presence or absence of dementia; the RCDI had a sensitivity of 88% and a specificity of 80% for specifically detecting probable Alzheimer's disease. Agreement between the RCDI and premortem diagnosis was 96%; between RCDI and medical records, 100%. Agreement between RCDI staging of dementia severity and the last assessment of the living subject was 70%; between the RCDI and a brief staging at death, 86%. This validation confirms the value of postmortem interviews with close informants to assess dementia presence and severity.
Determinants of increase in plasma concentration of beta-carotene after chronic oral supplementation. The Skin Cancer Prevention Study Group. We studied the relationship between eight variables, including age, sex, baseline plasma beta-carotene (BC) concentration, and smoking status and the increase in plasma BC in 582 subjects receiving oral supplementation with 50 mg BC/d. Median plasma BC concentrations after 1 y of supplementation increased from 335 nmol/L at entry to 3163 nmol/L. Changes in plasma BC concentrations ranged widely from -313 to 16,090 nmol/L (median 2721 nmol/L). Multivariate analysis revealed that the subject's plasma BC concentration before supplementation was the most important indicator of the amount of increase after supplementation. Nonsmokers, women, and leaner subjects all had larger increases in plasma concentrations although the statistical model could account for relatively little of the variability in subjects' plasma response to BC supplementation (R2 = 0.14). We conclude that between-subject variability in response to daily supplementation with oral BC is very large and that the best predictor of this response is the initial plasma BC concentration.
Ibuprofen provides longer lasting analgesia than fentanyl after laparoscopic surgery. The authors compared the analgesic efficacy of one dose of oral ibuprofen with that of intravenously administered fentanyl for relief of pain after outpatient laparoscopic surgery. Thirty healthy female patients received either 800 mg of oral ibuprofen preoperatively or 75 micrograms of intravenous fentanyl intraoperatively plus respective intravenous or oral placebos in a randomized, double-blind manner. Patients recorded their degree of pain and nausea in the recovery room, in the same-day surgery stepdown unit, during the ride home, and upon arrival at home. The postanesthesia care nurse recorded the amount of fentanyl and droperidol needed to treat pain and nausea in the recovery room. Patients who received ibuprofen were more comfortable in the stepdown unit (P less than 0.05) and after arrival home (P less than 0.05) than those in the fentanyl group. Additionally, patients who received ibuprofen had lower nausea scores in the step-down unit (P less than 0.05); this may have been related to the lower total fentanyl dose in these patients. The authors conclude that ibuprofen may be a useful alternative to fentanyl for providing postoperative analgesia for outpatient surgery.
Leiomyosarcoma of the buttock. A 56-year-old man had a deeply invasive leiomyosarcoma of the right buttock. Leiomyosarcomas of the skin and subcutaneous tissues are rare, and most occur on the extremities. Wide local excision is the therapy of choice.
Crohn's disease in a patient with multiple sclerosis. We report the occurrence of Crohn's disease in a patient with well-established multiple sclerosis. A relationship between inflammatory bowel disease and multiple sclerosis is supported by a higher than expected coexistence of these disease among families and individuals, as well as similar accepted and proposed mechanisms of pathogenesis and therapy.
Class I and class II major histocompatibility complex antigens on hepatocytes: importance of the method of detection and expression in histologically normal and diseased livers. Methodological differences in major histocompatibility complex (MHC) antigen detection were investigated on isolated, viable hepatocytes and cryostat hepatic sections from 27 children with liver disorders, six of whom had normal histology. Class I antigens were constantly found on sections using a three step immunoperoxidase technique after acetone/chloroform fixation, other techniques being less sensitive, or on isolated hepatocytes by indirect immunofluorescence alone. With mechanical isolation the percentage of positivity ranged from 85 to 100%, while with collagenase isolation it ranged from 22 to 49% on immediate testing, and from 53 to 80% after 24 hour incubation. Class II antigens were only detected in one patient with autoimmune chronic active hepatitis and two with primary sclerosing cholangitis. Flow cytofluorimetric analysis in 11 cases confirmed class II or class I positivity, or both, on isolated hepatocytes, allowing MHC antigen expression on hepatocytes to be measured. Class I and II antigen detection on hepatocytes is influenced by the technique used. Although class I antigens are invariably expressed on hepatocytes, class II antigens are only found on hepatocytes from patients with immune mediated liver disorders.
Stress echocardiography for detection of coronary artery disease. Stress echocardiography is a relatively new technique that combines cardiovascular stress with echocardiographic imaging for the diagnosis of coronary artery disease. It is based on the hypothesis that stress-induced ischemia will result in regional wall motion abnormalities that can be detected by two-dimensional echocardiography or abnormalities of global function that can be detected with Doppler ultrasound. Its accuracy for detecting coronary artery disease is high enough to allow for clinical use. In such a role it has added value to the analysis of the routine electrocardiogram and symptoms during exercise. In the patient unable to exercise, pharmacological stress with the use of dobutamine or dipyridamole are realistic alternatives. In addition to the diagnosis of coronary disease, stress echocardiography can be used to demonstrate recovery of function after interventions and to assess prognosis after myocardial infarction.
Premedication: an audit. A prospective study of routine premedication management was carried out at a large teaching hospital. Many patients received their premedication at times inappropriate for it to be effective. Several patients receiving regular medication had this suddenly stopped pre-operatively. Prolonged fasting occurred in both elective and emergency groups of patients. Benzodiazepines and opioids were prescribed most frequently and drying agents were used widely. Antacids, H2-blockers and agents to promote gastric emptying were used very little despite the potential of aspiration in many groups of patients. This audit of activity has revealed several areas of practice that can either be improved immediately or warrant detailed investigation.