shukoor65/lab-rag-model huggingface dataset:
Clinical study of infertile males with varicocele showing no typical radionuclide blood pooling on dynamic image of scrotal scintigraphy. A clinical study was done of 19 patients in our male infertility clinic, who were diagnosed as having a varicocele and showed atypical radionuclide accumulation in the dynamic image of scrotal scintigraphy. The semen quality was good in 26 percent and poor in 42 percent. Patients with severe congestion in the varicocele tended to be small in number. The dynamic images of the varicoceles were classified into two groups: one group with no radionuclide accumulation, and one group with patchy radionuclide accumulations. Surgical treatment was performed in patients with poor semen quality or with a long infertility period. Neither improvement in the semen quality nor impregnation was achieved postoperatively in patients who had shown no accumulation of the radionuclide in the dynamic imaging. In patients who had shown patchy radionuclide accumulations, the postoperative results were good. We concluded that preoperative dynamic imaging of scrotal scintigraphy is a good means of estimating the postoperative prognosis of fertility.
Central venous air embolism without a catheter. Venous air embolism is a well-recognized complication of central venous catheterization. Although previous reports have documented venous air embolism occurring in a number of ways, including during initial catheterization, when catheters crack or are disconnected, and after catheter removal, no reports mention the possibility of air embolism occurring when a guide wire without a catheter was in place. A patient is presented who displayed signs and symptoms of venous air embolism (tachypnoea, chest pain, and arterial hypoxaemia) during central venous catheter manipulation while a guide wire alone was in place. Pulse oximetry was used to detect hypoxaemia and suggest an aetiology for the patient's clinical symptoms. It is postulated that a previously described gasp reflex or some sort of sustained negative pressure manoeuvre caused venous air embolism around the guide wire and accounted for the patient's signs and symptoms. During central venous catheter placement, a high index of suspicion for venous air embolism should be maintained, pulse oximetry should be used, the skin entrance site should be kept covered by an occlusive dressing, and the patient should be positioned head-down.
Arm edema in conservatively managed breast cancer: obesity is a major predictive factor To identify risk factors in the development of arm edema (AE) after conservative management of breast cancer, the authors prospectively measured differences in upper and lower arm circumference in 282 patients with stage I or II breast cancer who received radiation. AE was defined as a difference of 2.5 cm or more in either measurement between treated and untreated arms. Median follow-up was 37 months (range, 7-109 months). The crude frequency of AE overall was 19.5% (55 patients). In 21 patients (7.4%) AE was transient; 34 patients (12.1%) had persistent AE, which is the focus of this article. The 5-year actuarial incidence of persistent AE was 16%. The crude risk of persistent severe AE was 3.9%. Various factors were examined for their ability to enable prediction of AE. Treatment-related factors did not significantly enable prediction of AE, whereas factors related to patient size, such as body mass index, were strongly associated with both the frequency and severity of AE.
Natural killer activity of human liver-derived lymphocytes in various liver diseases. Liver-derived lymphocytes were isolated from 40 human livers with end-stage liver disease that were removed at the time of orthotopic liver transplantation. In addition, 10 resection specimens or whole livers removed from patients with liver cancer and seven normal livers (unused donor organs) were studied as controls. Liver-derived lymphocytes were isolated from enzymatically digested tissue by gradient centrifugation and adherence to plastic. Their phenotypical characteristics were studied by two-color flow cytometry, and effector cell function was determined in 4-hr 51Cr-release assays against a natural killer-sensitive target, K562 (natural killer activity), natural killer-resistant Daudi line (lymphokine-activated killer activity) and by P815 line with or without phytohemagglutinin to assess lectin-dependent cellular cytotoxicity. Liver-derived lymphocytes isolated from normal liver contained equal proportions of T and natural killer lymphocytes (mean natural killer/T ratio = 0.7). CD3-CD56+CD16- natural killer cells were the main natural killer subset present in liver-derived lymphocytes, in contrast to the predominant natural killer phenotype in the circulation (CD56+CD16+). Control liver-derived lymphocytes had levels of cytotoxicity significantly greater than those of the normal peripheral-blood lymphocytes against all three targets. In contrast, liver-derived lymphocytes isolated from organs with advanced liver disease differed markedly in the natural killer/T cell ratio and levels of liver-derived lymphocyte cytotoxicity. Liver-derived lymphocytes obtained from hepatocellular carcinoma or rejecting allografts treated by immunosuppressive therapy had virtually no cytotoxicity.
Divided nevus of the eyelid. The two-stage surgical treatment of an adult female patient who presented with a congenital divided nevus of the left upper and lower lid is described.
Use of botulinum toxin in strabismus after retinal detachment surgery. Botulinum toxin was used to treat 20 patients with strabismus after retinal detachment surgery. Preinjection motility deviations ranged from 10 to 60 prism diopters (D). Postinjection deviations ranged from 0 to 20 prism D, with 75% being 10 D or less. Eighty-five percent achieved fusion that persisted, with 73% requiring only one or two injections. Only muscles in the eye that had undergone retinal reattachment surgery were injected. The average period of follow-up was 12 months. Complications were rare and all resolved spontaneously. Botulinum toxin appears to be useful as a primary treatment modality for persistent strabismus following retinal detachment surgery, possibly obviating the need for complicated strabismus surgery.
Limitations of open-chest cardiac massage after prolonged, untreated cardiac arrest in dogs. STUDY OBJECTIVES: Open-chest cardiac massage is an effective method of resuscitation if instituted within 15 minutes of normothermic cardiac arrest that has failed to respond to ongoing closed-chest CPR efforts. The usefulness of invasive forms of CPR after various periods of untreated cardiac arrest is less certain. This study was performed to determine the effectiveness of open-chest resuscitation after prolonged periods of untreated cardiac arrest. SETTING AND DESIGN: Prospective, controlled laboratory investigation using an animal model of cardiac arrest. Open-chest cardiac massage initially was compared to standard closed-chest compression CPR. The efficacy of open-chest CPR then was evaluated after ten and 40 minutes of untreated ventricular fibrillation. TYPE OF PARTICIPANTS: Twenty mongrel dogs (24 +/- 1 kg). MEASUREMENTS AND MAIN RESULTS: After 20 minutes of untreated ventricular fibrillation, open-chest resuscitation was significantly better than closed-chest efforts for the production of coronary perfusion pressure (58 +/- 14 vs 2 +/- 1 mm Hg; P less than .05) and initial resuscitation success (five of five vs one of five; P less than .03). Open-chest cardiac massage was equally effective for initial resuscitation if begun after ten or 20 minutes of untreated ventricular fibrillation (five of five vs five of five), but if untreated ventricular fibrillation continued for 40 minutes prior to instituting open-chest massage, no resuscitation benefit was found (none of five; P less than .005). There were marked differences in 24-hour survival depending on the length of time untreated cardiac arrest continued prior to instituting open-chest resuscitation efforts. After 20 minutes of ventricular fibrillation, initial resuscitation was successful with open-chest massage, but long-term survival was poor. CONCLUSION: Open-chest cardiac massage did not produce long-term survival if untreated cardiac arrest persisted for 20 or more minutes prior to invasive resuscitation efforts.
The impact of colonoscopy on colorectal carcinoma. In an eight-year, ongoing study of 120 patients, 39 with carcinomas and 81 with adenomas, no patient has produced a new carcinoma despite a high incidence of metachronous adenomas. Colonoscopy can identify early carcinomas that can be resected for cure. In addition, colonoscopy can identify the adenomatous polyps and with polypectectomy prevent the progression to carcinoma. Colonoscopy is more accurate than air contrast barium enema, provides a tissue diagnosis, and allows polypectomy. When applied according to risk factors known to be cost effective, colonoscopy leads to earlier diagnosis and thus improved long-term survival.
The influence of exercise-induced temperature elevations on the auditory brain-stem response (ABR). The influence of exercise on the auditory brain-stem response (ABR) was examined in 16 healthy volunteers (8 female and 8 male). Ipsilateral ABR recordings were obtained before and after exercise on a bicycle ergonometer. The rise of body temperature so generated was 0.5-2.1 degrees C (mean, 1.3 degrees C) as measured in the contralateral external auditory meatus. Latencies of waves III and V (but not wave I) were found to be significantly lower immediately post-exercise (P less than 0.01). The temperature relations of the latency of wave V are described by the regression equation: Latency (ms) = 11.06-0.146 x temp. (degrees C). (The effects on amplitude were not significant, nor were male/female differences.) It is suggested that exercise hyperthermia could be an appropriate model for the evaluation of the ABR in fever.
Vagal stimulation and prevention of sudden death in conscious dogs with a healed myocardial infarction. The interest for the antifibrillatory effect of vagal stimulation has been largely limited by the fact that this concept seemed restricted to acute experiments in anesthetized animals. To explore the potentially protective role of vagal stimulation in conscious animals we developed a chronically implantable device to be placed around the cervical right vagus. An anterior myocardial infarction was produced in 161 dogs; 1 month later an exercise stress test was performed on the 105 survivors. Toward the end of the test the circumflex coronary artery was occluded for 2 minutes. Fifty-nine (56%) dogs developed ventricular fibrillation and, before this test was repeated, were assigned either to a control group (n = 24) or to be instrumented with the vagal device (n = 35). Five dogs were excluded because of electrode malfunction. Compared with the heart rate level attained after 30 seconds of occlusion during exercise in the control test, vagal stimulation led to a decrease of approximately 75 beats/min (from 255 +/- 33 to 170 +/- 36 beats/min, p less than 0.001). In the control group 22 (92%) of 24 dogs developed ventricular fibrillation during the second exercise and ischemia test. By contrast, during vagal stimulation ventricular fibrillation occurred in only 3 (10%) of the 30 dogs tested and recurred in 26 (87%) during an additional exercise and ischemia test in the control condition (p less than 0.001 versus the vagal stimulation test; internal control analysis). Combined analysis of the tests performed in the control condition showed that ventricular fibrillation was reproducible in 48 (89%) of the 54 dogs tested. The protective effect of vagal stimulation was also significant in the group comparison analysis and even after exclusion of those four dogs in which ventricular fibrillation was not reproducible (92% versus 11.5%, control versus vagal stimulation, p less than 0.001). When heart rate was kept constant by atrial pacing, the vagally mediated protection was still significant (p = 0.015) as five (55%) of nine dogs survived the test. This study shows that vagal stimulation, performed shortly after the onset of an acute ischemic episode in conscious animals with a healed myocardial infarction, can effectively prevent ventricular fibrillation. This striking result seems to depend on multiple mechanisms having a synergistic action. The decrease in heart rate is an important but not always essential protective mechanism. The electrophysiological effects secondary to the vagally mediated antagonism of the sympathetic activity on the heart are likely to play a major role.
Analysis of beta, gamma, and delta T-cell receptor genes in mycosis fungoides and Sezary syndrome. The authors have analyzed the configuration of immunoglobulin (Ig) and beta, gamma and delta T-cell receptor (TCR) genes in DNA extracted from skin, lymph nodes, and peripheral blood mononuclear cells obtained from 41 patients with mycosis fungoides (MF), 14 patients with Sezary syndrome, and 13 patients with benign inflammatory dermatoses. No discrete rearranged bands (DRB) were detected in patients with inflammatory dermatoses. In tissue DNA from 19 patients with MF DRB were detected with beta and gamma, but not delta TCR probes. Only one patient with MF had a rearrangement of gamma and delta with germ line beta TCR genes. In 13 patients multiple biopsies were analyzed and DRB, when present, were identical in different lesions from individual patients. In three patients analysis of DNA from dermatopathic lymph nodes did not reveal DRB. Analysis of peripheral blood DNA from 24 patients revealed a discrete rearrangement of the gamma TCR gene in four patients and both beta and gamma genes in four additional patients. In MF DRB were detected more frequently with advancing stage of disease in tissues (P less than 0.01) but not in peripheral blood (P equals 0.36). Of 14 patients with Sezary syndrome, eight had DRB in peripheral blood DNA with both beta and gamma probes and in three of these patients identical DRB were also detected in DNA from skin biopsy samples. In contrast, DRB were not detected in the peripheral blood of the other six patients. In both MF and Sezary syndrome there was no restricted usage of particular V gamma genes. These results indicate that in MF (1) T-cell clones can be detected in skin biopsy specimens from the majority of patients with early stage disease, (2) gamma delta T-cell clones are only rarely found, and (3) TCR gene analysis can detect T-cell clones in the peripheral blood with a greater degree of specificity than conventional light microscopic study. In Sezary syndrome these studies also suggest that a subset of patients have a polyclonal population of circulating atypical lymphoid cells. In addition these patients appear to have a better prognosis than those with monoclonal disease.
Soft tissue Ewing's sarcoma. Characterization in established cultures and xenografts with evidence of a neuroectodermic phenotype. This study characterizes the histogenesis of soft tissue Ewing's sarcoma (StEs) based upon an analysis of three tumors. Long-term cultured cell lines and nude mice xenografts were established from original neoplasms or from their metastases. Histologically they revealed a small round cell pattern without signs of differentiation. Several ultrastructural features of neural type were found; the same were also seen on culture cell lines. Moreover, immunohistochemical study for neural markers revealed the presence of HNK-1, NSE, LIRC-LON 36, S-100 protein, glial fibrillary acidic protein, neurofilaments (70 kilodaltons), and chromogranin; some of these markers were present only in the transplants. Cytokeratin was also seen. The translocation t(11;22)(q24;q12) was found in all three neoplasms together with other chromosomal abnormalities. N-myc RNA gave negative results whereas c-myc RNA was expressed. Therefore it may be postulated that StEs displays neuroectodermal features somewhat similar to those seen in peripheral neuroepithelioma as well as in atypical Ewing's sarcoma of bone.
Prevention of restenosis by lovastatin after successful coronary angioplasty. Prevention of restenosis after successful percutaneous transluminal coronary angioplasty (PTCA) remains a major challenge. To determine whether lovastatin could prevent restenosis, between December 1987 and July 1988, a total of 157 patients undergoing successful PTCA were randomly and prospectively assigned to the lovastatin group or a control group. Seventy-nine patients received lovastatin (20 mg daily if the serum cholesterol level was less than 300 mg/dl and 40 mg daily if the serum cholesterol level was greater than or equal to 300 mg/dl) in addition to conventional therapy (lovastatin group). Seventy-eight patients received conventional therapy alone (control group). Fifty patients in the lovastatin group and 29 in the control group were evaluated with coronary angiography at an interval of 2 to 10 months (mean 4 months). The restenosis rate was evaluated according to the number of patients showing restenosis, the number of vessels restenosed, and the number of PTCA sites restenosed. Restenosis was defined as the presence of greater than 50% stenosis of the PTCA site. In the lovastatin group 6 of 50 patients (12%) had restenosis compared with 13 of 29 patients (44.4%) in the control group (p less than 0.001). When the number of vessels restenosed was considered, only 9 of 72 vessels (12.5%) restenosed in the lovastatin group compared with 13 of 34 vessels (38.2%) in the control group (p less than 0.002). Similarly, 10 of 80 (12.5%) PTCA sites restenosed in the lovastatin group compared with 15 of 36 (41.7%) in the control group (p less than 0.001).
Intraoperative monitoring of facial nerve function in cerebellopontine angle surgery. Facial nerve paralysis associated with cerebellopontine angle surgery has been reported to range up to 26% in a recent series. Various methods of intraoperatively monitoring the facial nerve have been developed to reduce the incidence of facial paralysis. We report our experience with an intraoperative monitoring technique using intramuscular EMG electrodes to detect subclinical electrical responses that were amplified and made audible to the operating surgeon after gating stimulus artifacts. A 3.6% incidence of facial paralysis in 111 consecutive cases with this intraoperative monitoring method compared with 14.5% in 207 previously unmonitored cases indicates significant reduction of this complication in cerebellopontine angle surgery (p less than 0.001). Along with this reduction in facial paralysis, an increase in the percentage of partial facial paresis was observed in the monitored group (p less than 0.05). The percentage of those with intact facial function was similar in the monitored (82.0%) and unmonitored groups (78.3%).
Transient pulsus alternans induced by isosorbide dinitrate: echocardiographic and hemodynamic evidence of reduced venous return--a case report. Transient pulsus alternans was induced by isosorbide dinitrate (ISDN) in a patient with postmyocarditis congestive heart failure under diuretic therapy. The severity and duration of pulsus alternans depended on the dose of ISDN. According to the echocardiographic and hemodynamic examinations, the superimposed preload reduction caused by ISDN combined with decreased blood volume owing to diuretic therapy most likely contributed to the development of pulsus alternans.
Common reactions to transfusions. A blood transfusion is a special kind of transplantation, with the transfer of living tissue from one person to another. Reactions can occur with as little as 10 to 15 ml of incompatible blood. The onset of a reaction may be misleading or delayed, and its detection requires astute assessment. Responsibility for recognition of a transfusion reaction lies with the transfusionist, who is often a nurse. The following types of response can occur: hemolytic reactions, transfusion-induced graft-versus-host disease, hemoglobinuria, purpura, fever, circulatory overload, thrombophlebitis, urticaria, hyperkalemia, asymptomatic hemoglobinuria, pulmonary edema, and allergic and anaphylactic reactions. Critical care nurses need to be aware of the dangers of blood and blood product transfusions and to be prepared to react quickly.
Presentation of acute uterine inversion in the emergency department. A case of acute puerperal uterine inversion is described in a patient who presented to the emergency department after a home birth and a prolonged third stage of labor. The cardinal findings were shock and excessive blood loss. The uterus and attached placenta were protruding from the vagina and the normal cervical landmarks were absent. Emergency management consisted in vigorous fluid resuscitation prior to transfer to the operating room for definitive reversion.
Obliterations of the proximal subclavian artery: to bypass or to anastomose? A clinical series has been analysed to determine which of two similar, extrathoracic "extraanatomic" methods of treating proximal blocks of the subclavian artery is the superior option. From 1975 until 1988 direct carotid-subclavian anastomosis was used in 32 patients and carotid-subclavian bypass in 19. There were no statistically significant differences for the probability of postoperative survival (p less than 0.877 Breslow; p less than 0.774 Mantel), intraoperative blood loss or the duration of anaesthesia. Those patients who had undergone subclavian artery repair had a significantly longer survival than those following carotid bifurcation endarterectomy (p less than 0.002 Breslow, p less than 0.0002 Mantel). As patients with subclavian lesions have a reasonable life-expectancy, they may possibly experience late complications of their vascular repair. Therefore it seems important to select the most durable operation, and direct carotid subclavian anastomosis has a significantly greater patency rate than bypass (p less than 0.006 Breslow, p less than 0.006 Mantel). Patients with preoperative symptoms of cerebrovascular insufficiency had a lower probability of survival than those with upper extremity claudication, although this did not reach statistical significance (p less than 0.205 Breslow; p less than 0.198 Mantel).
Practical approach to the diagnosis of unexplained chest pain. Chest pain is a frequent medical problem causing concern for both patients and physicians. A multidisciplinary meeting recently developed algorithms for evaluating these patients in the two most common scenarios for the presentation of chest pain: (1) new onset of chest pain in the primary care setting, and (2) recurrent chest pain in the the referral setting. In both situations, the primary care physician, rather than specialists, should direct the evaluation and treatment of patients with chest pain and normal coronary angiograms.