shukoor65/lab-rag-model huggingface dataset:
Clinical application of a patient-controlled apparatus for ventricular administration of morphine in intractable pain: report of 28 cases. The authors developed a patient-controlled apparatus (L-224) for ventricular administration of pain-relieving medication and utilized it in the treatment of 28 patients with intractable pain. The initial dose of morphine hydrochloride was 1 mg, which afforded pain relief for an average of 170 hours. At an average dose of 1.8 mg, the average time of pain relief obtained was 137 hours. Therefore, they conclude that L-224 is a satisfactory apparatus for the ventricular administration of pain medication; it is patient controlled, safe, and reliable in clinical application.
Pulmonary function of preeclamptic women receiving intravenous magnesium sulfate seizure prophylaxis. Pulmonary function was studied in ten preeclamptic women in labor (mean gestational age 38.1 +/- 0.9 weeks measured from the last menstrual period) receiving continuous intravenous (IV) infusions of magnesium sulfate. Baseline maximal inspiratory pressure, maximal expiratory pressure, functional vital capacity, and forced expiratory volume at 1 second were measured immediately before a 6-g IV loading dose of magnesium sulfate and 2 hours after the initiation of a continuous 2-g/hour infusion of magnesium sulfate. Serum magnesium levels were measured at the same time pulmonary function tests were performed. All values are reported as the mean +/- standard deviation. The maximal inspiratory pressure, an indicator of generalized respiratory muscle weakness, decreased from a baseline value of 26.2 +/- 7.7 to 19.4 +/- 6.3 cm H2O (P less than .05). The maximal expiratory pressure, an indicator of expiratory muscle strength, decreased from a baseline value of 30.6 +/- 9.2 to 25.2 +/- 7.1 cm H2O (P less than .005). The functional vital capacity decreased from a baseline value of 3.37 +/- 0.49 to 3.19 +/- 0.73 L, and the forced expiratory volume at 1 second decreased from a baseline value of 2.61 +/- 0.58 to 2.36 +/- 0.68 L at 2 hours (P less than .05). The mean serum magnesium level was 1.7 +/- 0.2 mg/dL before the administration of the IV loading dose and 4.51 +/- 0.67 mg/dL 2 hours after initiation of the continuous infusion. Our results demonstrate a significant decrease in pulmonary function tests in term preeclamptic patients receiving magnesium sulfate for seizure prophylaxis.
Androgens and oligomenorrhea in hirsute women. A recent study demonstrated that hirsute women with irregular menses had higher levels of serum androgens that hirsute women with regular menses. To investigate this finding, we measured total testosterone, biologically active testosterone, free testosterone, androstenedione, dehydroepiandrosterone, and dehydroepiandrosterone sulfate in 51 hirsute women with regular menses and compared the levels found to those found in 28 hirsute women with oligomenorrhea. There was no significant difference in the degree of facial hirsutism between the two groups. Oligomenorrheic women had significantly higher levels of free testosterone (p less than 0.02) and biologically active testosterone (p less than 0.05). The other androgens did not differ significantly between the two groups. The free fractions of testosterone are the metabolically active forms of the hormone and their levels are a function of the rates of production and clearance of testosterone that are elevated in states of hyperandrogenism. This study confirms that hirsute women with oligomenorrhea have higher levels of free and biologically active testosterone than those with regular menses.
Clinical experience with oral sumatriptan: a placebo-controlled, dose-ranging study. Oral Sumatriptan Dose-defining Study Group. A double-blind, placebo-controlled multicentre study was carried out to evaluate the efficacy and tolerability of 100, 200 and 300 mg sumatriptan, a selective 5-hydroxytryptamine (5-HT)1-like receptor agonist, given in an oral dispersible form in the acute treatment of migraine attacks. A total of 1130 patients were recruited from 51 centres in eight countries and the efficacy results are presented from an interim analysis of 538 cases. Tolerability was evaluated in 227 patients. At 2 h, an improvement in headache severity from moderate or severe to mild or none was reported by 67% of patients who received 100 mg sumatriptan, 75% receiving 200 mg and 69% of patients receiving 300 mg sumatriptan, compared with 22% of patients who received placebo (P less than 0.001 all doses sumatriptan vs placebo). Adverse events were generally mild and transient, and appeared to be dose-related; the adverse event profile of 100 mg sumatriptan was similar to that of placebo. Overall, nausea/vomiting and "bitter taste" were the most common complaints. The proportion of patients withdrawn due to adverse events was similar in the placebo and 100 mg sumatriptan treatment groups (2% and 3%, respectively). It is concluded that 100 mg sumatriptan given orally is well tolerated with an anti-migraine efficacy comparable to that provided by the two higher doses.
Effect of sequential early burn wound excision and closure on postburn oxygen consumption. OBJECTIVE: To determine the effect of early excision and closure of burns on postburn hypermetabolism, measured as oxygen consumption (VO2). METHODS: Twelve patients with deep burns of 30% to 50% of total body surface underwent sequential excisions and wound coverage, beginning 1 to 3 days after burn. The majority of the deep burn was removed by day 7, but with the addition of a donor site area of 20% to 25% of total body surface. RESULTS: No decrease in VO2 was noted in relation to the percent removal of burn tissue. In addition, a transient further increase in VO2 was noted early after excision, especially with surgical procedures performed after 5 days. This response could not be attributed to wound manipulation-induced bacteremias. CONCLUSION: We conclude that early surgical excision and closure of burns in excess of 30% to 50% of total body surface do not decrease postburn hypermetabolism in proportion to the area closed. It is possible that remaining open wounds in the form of donor sites and nonexcised burn are sufficient to perpetuate the hypermetabolic process, once established.
Transanal electrostimulation for fecal incontinence: clinical, psychologic, and manometric prospective study. A prospective study was carried out to analyze the clinical, psychologic, and manometric short-term results of transanal electrostimulation (TES) in the treatment of fecal incontinence. Fifteen patients underwent TES. An initial clinical and manometric assessment was carried out before and 1 month after the procedure. A psychologic evaluation was also performed by means of interviews and appropriate tests. Early improvement of symptoms was noted in 10 patients. The nonresponders were women with gross daily incontinence to solid stool. At anal manometry, resting tone and rectal sensation remained unchanged, whereas a significant increase of voluntary contraction was observed following TES (from 48 +/- 26 to 59 +/- 39 mm Hg, P = 0.03). Psychologically, TES led to a significant decrease of both latent and paranoid anxiety related to symptoms (P = 0.02). At a clinical reassessment 6 months later, one of the nonresponders became continent after a further course of TES. In conclusion, TES is well accepted by the patients, is followed by positive emotional response, and, by improving striated sphincter function, seems to be effective in the treatment of partial fecal incontinence.
Combination thrombolytic therapy: a comparison of simultaneous and sequential regimens of tissue plasminogen activator and urokinase. Coronary angioplasty following unsuccessful tissue plasminogen activator (t-PA) therapy for acute myocardial infarction has been associated with a high incidence of subsequent reocclusion of the infarct-related artery, and a relatively high in-hospital mortality. In contrast, the combination of t-PA and urokinase, when given intravenously prior to coronary angiography, appears to be associated with a low incidence of post-rescue angioplasty reocclusion. In order to determine whether intraprocedural urokinase, given at the time of rescue coronary angioplasty for failed t-PA therapy, improves long-term patency of the infarct vessel to the same extent as preangiographic, combination t-PA/urokinase therapy, three thrombolytic treatment strategies were retrospectively compared. The first group included 86 patients undergoing rescue angioplasty after t-PA monotherapy (t-PA alone). The clinical and angiographic outcomes of these patients were compared with those of 24 patients who received intravenous or intracoronary urokinase during rescue angioplasty following unsuccessful t-PA therapy (sequential t-PA/urokinase therapy), and with those of 34 patients undergoing rescue coronary angioplasty following unsuccessful therapy with the combination of intravenous t-PA and urokinase (simultaneous therapy). There was no difference in postangioplasty patency rate of the infarct-related artery between the three groups. However, the sequential t-PA/urokinase regimen was associated with a subsequent reocclusion rate that was lower than the rate that occurred in the t-PA monotherapy group but higher than the rate in the simultaneous t-PA/urokinase group (13 versus 29 versus 2%, respectively; p = 0.003).
A femoral vein-femoral artery loop technique for aortic dilatation in children. Balloon aortic dilatation is now a recognized therapy for aortic stenosis in children. Using retrograde approaches with either single or double balloons, successful dilatation can be readily achieved, but with little control of balloon position across the valve. We describe a femoral vein-femoral artery loop technique via a transseptal approach which facilitates antegrade crossing of the stenotic aortic valve and allows optimal balloon control and simultaneous pressure gradient recording during the procedure.
Acceleration of chronic myeloid leukemia correlates with calcitonin gene hypermethylation. Calcitonin gene methylation at CCGG sites were determined in 39 chronic myeloid leukemia patients by isoschizomeric restriction endonuclease analysis. A total of 27 patients were analyzed while still in the chronic phase: 20 patients had a normal gene, and seven had a hypermethylated gene. There were 12 patients initially studied in accelerated or blastic phases. All but one patient showed gene hypermethylation, suggesting a good correlation between gene methylation and disease stage. All five patients who, while still in the chronic phase, had a major 3.1-kb hypermethylated calcitonin gene fragment, accelerated within 2 to 27 months. In consecutively analyzed patients, the initially normal calcitonin gene changed to a hypermethylated state as the disease escalated. The hypermethylation predicted disease acceleration with a median lead time of 6 months before any morphologic or clinical signs of disease progression were seen. The disease progressed in 8 of 27 patients initially studied in the chronic phase: in only two patients this occurred without predictive methylation changes. The results suggest that the assessment of calcitonin gene methylation status may be a promising tool for monitoring chronic myeloid leukemia disease escalation.
Fibrinolysis in cerebrospinal fluid after intraventricular haemorrhage. Concentrations of cross linked fibrin degradation products were measured in the cerebrospinal fluid from five 'normal' preterm infants (median 102 ng/ml), four preterm infants with intraventricular haemorrhage (median 315 ng/ml), and five infants with progressive post-haemorrhagic ventricular dilatation (median 1000 ng/ml). Serial samples of cerebrospinal fluid from one infant showed a peak concentration two weeks after the haemorrhage.
A prospective study of outcome from protein-energy malnutrition in nursing home residents. To study recovery from protein-energy malnutrition in patients newly admitted to a chronic care facility, biochemical and anthropomorphic malnutrition indicators were measured prospectively over a 2-month period. Subjects were observed for a mean of 76 +/- 18 days after admission. Factors which might affect nutritional status including method of feeding, energy prescribed, use of supplemental feedings, assistance in eating, and amount of diet consumed were recorded. Confounding variables including illness, mental status, functional status, or prescription drugs were evaluated for their impact. On the basis of an empiric nutrition score, 54% of newly admitted residents were malnourished. Improvement in nutritional score occurred in 63% of malnourished patients remaining in the facility whereas 37% remained malnourished. Two related factors, percentage of diet consumed and degree of assistance required in eating, were important differences in the outcome of patients remaining malnourished. Interventional studies to determine whether outcome can be improved by more aggressive feeding methods or by feeding teams need to be undertaken.
Lack of evidence for small vessel disease in a patient with "slow dye progression" in the coronary arteries. A patient with chest pain of recent onset, suggestive for angina pectoris, was referred for diagnostic coronary angiography, which showed the typical phenomenon of "slow dye progression" in the absence of any significant coronary artery stenosis. While intracoronary Doppler measurements confirmed the extremely slow blood flow velocity, the coronary flow reserve and the calculated coronary blood flow proved to be within normal range. The present findings suggest that, in contrast with a previous hypothesis, the phenomenon of slow dye progression may not always be due to a microvascular cause. Epicardial artery disease, as suggested by the marked coronary artery ectasia, may be linked to the slow dye progression and predispose to coronary artery thrombosis.
Rotationplasty as a reconstructive operation after tumor resection. Reconstruction in the skeletally immature patient following resection of osteosarcoma about the knee is a challenging problem. Salvaging of the limb with allogeneic or prosthetic replacement results in a shortened limb with functional limitations. Arthrodesis yields a stiff and shortened limb. The so-called growing prosthesis has a high complication rate and is still unproven. However, rotationplasty has been successfully used as a reconstructive technique following resection of these types of tumors in the skeletally immature patient. A limb with normal sensation and proprioceptions, adequate range of motion, and without leg-length discrepancies, functional limitations, or painful neuroma is to be expected. Although a prosthesis must be worn, these patients are active and participate in unrestricted physical activity. Cosmetic acceptance has not been a problem and complications are minimal. Thus, rotationplasty requires only a single operation and results in a highly functional limb.
Impaired efficacy of selective LDL-apheresis in primary biliary cirrhosis. Low-density lipoprotein apheresis (LDL-apheresis) was done with either cascade filtration (DF) or dextran sulfate cellulose adsorption (DSC) in a patient with primary biliary cirrhosis who developed severe dyslipidemia associated with cholestasis and accumulation of lipoprotein-X (LP-X). The extracorporeal treatment was initially performed weekly, and resulted in a sharp drop in total cholesterol from 1038 to 430 mg/dl. During the next four months the patient was treated every 10-15 days, and pre-apheresis cholesterol levels were maintained between 438 and 505 mg/dl, until an orthotopic liver transplantation was successfully performed. With semi-selective DF a mean 47.1% of total cholesterol was removed per procedure compared to 30.0% with DSC, although the volume of treated plasma was 38.0 vs 49.9 ml/kg body weight. The changes in plasma cholesterol levels during DSC and DF showed that the kinetics of cholesterol removal were similar with both techniques, but the efficacy differed; DF removed both LDL and LP-X from plasma, whereas DSC selectively lowered the LDL content. Cascade filtration may therefore be considered as a first-choice treatment for patients with LP-X accumulation due to cholestasis.
Chronic hematocele complicating renal failure and hemodialysis. A patient with a recent history of genitourinary tuberculosis, chronic renal failure and hemodialysis presented with a slow growing scrotal swelling that had enlarged during the last 3 years. Physical examination and sonography were suspicious for testicular tumor, and surgical exploration and inguinal orchiectomy were performed. Ultimately the mass proved to be a chronic hematocele, a rare complication of uremic coagulopathy and hemodialysis. Because hematocele may clinically and sonographically resemble a testicular tumor, the proper management of a complex multiseptated scrotal mass without obvious history suggestive of hematocele is surgical exploration and orchiectomy. Awareness of this common presentation may obviate orchiectomy.
Pulmonary intravascular lipid in neonatal necropsy specimens. The lungs of 482 liveborn infants were examined at necropsy for the presence of intravascular lipid. Forty one patients had received parenteral feeding (including lipid emulsion in 30), and 441 had died before starting feeds or had received enteral feeds alone. Tissue was processed into wax and then stained with Sudan black; intravascular lipid was found in 15 of 30 infants who had received intravenous fat (Intralipid), but in no others. Those patients with positive lipid staining had received significantly more fat during parenteral nutrition than those in whom intravascular lipid was not found but the two groups were otherwise clinically indistinguishable. Using this staining technique intravascular lipid can be shown relatively often, although only in patients who have received intravenous lipid emulsion. The location of fat, predominantly in small pulmonary capillaries, and the absence of lipid emboli in other organs, suggests that lipid coalescence takes place before death and is not a postmortem artefact. The clinical relevance remains uncertain.
Current surgical technique to repair Fallot's tetralogy with absent pulmonary valve syndrome. The experience with surgical repair of Fallot's tetralogy and absent pulmonary valve syndrome is reviewed. Twenty-two patients aged 1 day to 8 years were treated between 1982 and 1989 using one surgical technique. This consisted of resection of the main pulmonary artery and large parts of the anterior wall of the right and left pulmonary artery. The ventricular septal defect was closed with a patch, and an aortic or pulmonary homograft (size, 8 to 24 mm) was interposed between the right ventricle and the pulmonary artery. Two of the 8 infants operated on died; there was one late death. All 14 older children survived the operation. All survivors are well up to 7 years follow-up (mean follow-up, 3.6 years). We recommend early treatment of infants; older children can be treated electively. The technique used in our series gives excellent results.
Pheochromocytoma in a long-term hemodialysis patient. A right adrenal tumor was found incidentally by renal echography in a 25-year-old man, who had been on hemodialysis for 4 years. Inquiry and clinical examination suggested pheochromocytoma, which was confirmed by plasma catecholamine measurements. Subsequent adrenalectomy was uneventful. Although hypertension, headache, and diaphoresis are common symptoms in a dialyzed patient, pheochromocytoma has to be eliminated in the presence of this clinical triad.
Results of total cavopulmonary connection in the treatment of patients with a functional single ventricle. Total cavopulmonary connection was proposed as a modification of the Fontan procedure that might have greater benefits than previous methods. To assess this procedure we reviewed case histories of 38 patients (aged 17 months to 30 years) who underwent Fontan procedures with cavopulmonary anastomoses between January 1987 and December 1989. The group included 32 patients with univentricular heart, 2 with pulmonary atresia and intact ventricular septum, 3 with tricuspid atresia, and 1 with hypoplastic left heart syndrome. One or more previous palliative procedures were performed in 34 patients, including 19 systemic-pulmonary shunts, 16 pulmonary artery bandings, 7 atrial septectomies/septostomies, 7 Glenn shunts, and 1 patent ductus arteriosus ligation. Preoperative hemodynamics showed a pulmonary artery pressure of 12 mm Hg (range 6 to 22 mm Hg), pulmonary-systemic flow ratio of 1.6 (range 0.37 to 3.0), left ventricular end-diastolic pressure 9 mm Hg (range 3 to 15 mm Hg), and systemic arterial oxygen saturation of 82% (range 67% to 94%). Concomitant with cavopulmonary connection, 13 patients underwent additional procedures, including 9 atrioventricular valve annuloplasties, 4 Damus-Stansel-Kaye procedures, and 2 resections of subaortic membranes. Modifying the Fontan procedure in this fashion was particularly useful in the management of 2 patients with pulmonary atresia and intact ventricular septum who had right ventricular-dependent coronary blood flow. Cavopulmonary anastomosis and atrial septectomy were performed in both patients, with resultant inflow of oxygenated blood to the right ventricle and coronary arteries. Excellent postoperative results were noted in each. Postextubation hemodynamics for the entire group included a mean right atrial pressure of 13 mm Hg (range 11 to 17 mm Hg), a mean left atrial pressure of 6 mm Hg (range 3 to 12 mm Hg), and a room air oxygen saturation of 96% (range 92% to 98%). Seven patients had pleural effusions, 3 required postoperative pacemaker placement, and 2 required reoperation for tamponade. A venous assist device was required in one patient on the second postoperative day, but the patient was weaned successfully within 24 hours. One early death (2.6%) occurred in a patient who had intractable ventricular fibrillation 2 days after operation. There was one late cardiac death (2.7%) caused by ventricular failure and one late noncardiac death. These results demonstrate that total cavopulmonary connection provides excellent early definitive treatment, with low morbidity and mortality, for a variety of complex congenital heart lesions.
Evaluating South Carolina's community cardiovascular disease prevention project. A community cardiovascular disease prevention program was undertaken as a cooperative effort of the South Carolina Department of Health and Environmental Control and the Centers for Disease Control of the Public Health Service. As part of the evaluation of the project, a large scale community health survey was conducted by the State and Federal agencies. The successful design and implementation of the survey, which included telephone and in-home interviews as well as clinical assessments of participants, is described. Interview response rates were adequate, although physical assessments were completed on only 61 percent of those interviewed. Households without telephones were difficult and costly to identify, and young adults were difficult to locate for survey participation. The survey produced baseline data for program planning and for measuring the success of ongoing intervention efforts. Survey data also have been used to estimate the prevalence of selected cardiovascular disease risk factors.