shukoor65/lab-rag-model huggingface dataset:
The cognitive and psychological sequelae of uncomplicated aneurysm surgery. Many patients are left with psychological symptoms after surgery for a ruptured intracranial aneurysm. Often the reason for these symptoms is not clear. A prospective study was carried out of 27 patients who were in a good (Grade 1 or 2) condition before operation to identify the origin of such symptoms and discover whether the basic techniques of aneurysm surgery could lead to serious psychological sequelae even in the absence of any specific complication. Each patient was given a modified psychometric assessment just before surgery and at the time of discharge from hospital. One year later a full psychometric and social assessment was carried out. Even a temporary worsening of psychometric performance did not occur unless there had been some specific surgical or post-operative problem. Five patients showed worsening of psychometric performance in the immediate post-operative period but by one year, only two of the 27 patients showed any abnormalities on formal psychometric evaluation; in both, clear reasons were evident. Although the majority of patients reported minor psychological symptoms, these had not hindered full functional recovery, and we doubt whether they had any organic basis. It is concluded that aneurysm surgery does not, itself, threaten higher intellectual function unless some specific complication occurs.
Expression of haptoglobin-related protein in primary and metastatic breast cancers. A longitudinal study of 48 fatal tumors. The ability to establish a prognosis for patients with early breast cancer is an important clinical issue. Recent studies have shown that antibodies to haptoglobin-related protein (Hpr) may be useful in stratifying early patients with breast cancer according to their relative risks of recurrence. Nearly 30% of early breast cancers express proteins bearing Hpr epitopes. Hpr-positive breast cancers are more likely to recur after primary resection and are associated with shorter disease-free intervals. This immunohistochemical study examines temporal changes in Hpr expression during the course of disease in 48 patients with fatal breast carcinoma. Thirty-seven primary tumors (77%) were Hpr positive. Ten of the 11 initially negative tumors (91%) were Hpr positive at the time of recurrence. In contrast, only 10 of the 37 initially positive tumors (27%) were Hpr negative with relapse. Of 18 axillary nodes that were examined, 16 (89%) were Hpr positive; all four lymph nodal metastases in patients with initially negative primary tumors were Hpr positive. The authors conclude that the acquisition of Hpr expression parallels increased malignant potential and that Hpr expression, once acquired, tends to remain a permanent characteristic of any given mammary tumor.
Valve deformity and balloon mechanics in percutaneous transvenous mitral commissurotomy. Percutaneous transvenous mitral commissurotomy (PTMC) using balloon catheters has emerged as an alternative therapeutic modality for patients with mitral stenosis. When used initially in the United States, a single balloon, designed for peripheral arterial angioplasty, was passed across the intraatrial septum for mitral dilatation. The results were less than ideal, with resultant valve areas between 1.0 and 1.5 cm2. Double balloon dilatation was introduced and yielded valve areas between 1.5 and over 2.0 cm2. However, the double balloon technique is substantially more cumbersome, requires passage of two catheters through the atrial septum with an incidence of atrial septal defect, and results in significant hemodynamic sequelae during the procedure. This report describes a novel single balloon for PTMC. In contrast to the more conventionally used peripheral arterial balloons, this device was specifically designed for mitral stenosis. Results in 25 patients (mean age 60 +/- 5 years; range 29 to 87 years) showed an increase in value area from 0.9 +/- 0.2 cm2 to 1.6 +/- 0.5 cm2 (p less than 0.001). In contrast to the results reported with conventional balloon dilatation, there was no difference in the resultant valve area or in the incidence of complications among patients with more severely deformed valves compared with patients with more "ideal" valves for commissurotomy. An in vitro comparison of the pressure-volume characteristics of the conventional versus the Inoue balloon showed the latter to be more compliant, reaching nominal inflated diameter at 2.0 +/- 0.4 atm versus 3.3 +/- 0.5 atm for conventional balloons (p less than 0.005).
Comparison of insect species associated with decomposing remains recovered inside dwellings and outdoors on the island of Oahu, Hawaii. A comparison of insects collected from 35 cases of decomposing remains on the island of Oahu, Hawaiian Islands (14 from indoor situations and 21 from outdoors), yielded a total of 22 species of insects in 3 orders and 12 families. Of these, five species were recovered in both indoor and outdoor situations. Remains recovered indoors had a greater variety of Diptera larvae associated with them, while remains discovered outdoors had a greater variety of Coleoptera species present. Some species of insects were restricted to remains discovered indoors, while others were found only associated with remains in outdoor situations. Knowledge of the species of insects associated with different habitats may serve to provide information concerning the history of the remains.
What does Cruzan mean to the practicing physician? The United States Supreme Court's recent decision in the Cruzan case declared that the states have broad powers to formulate their own rules in "right to die" cases. The Court held that competent adults have a constitutionally protected "liberty interest" that allows them to accept or refuse medical treatments. Since liberty interests are subject to rational state regulation, the narrow holding in Cruzan affirmed Missouri's authority to require a "clear and convincing" evidence standard to determine a patient's wishes before life-sustaining treatment could be withdrawn from a formerly competent adult now in a persistent vegetative state. For practicing physicians, some of the implications of Cruzan are as follows: (1) For competent adult patients, physicians should respect patient wishes regarding life-sustaining treatment. (2) Physicians also should discuss with competent patients their wishes for life-sustaining treatment at a future time, when a patient may no longer be able to participate in such decisions. (3) Physicians should record these wishes in a legally acceptable instrument that addresses two aspects of care that may arise in the future if the patient becomes incompetent. What would the patient want done? Who would the patient wish to designate as a surrogate or proxy? (4) For patients who are now incompetent, but for whom decisions must be made about life-sustaining treatment, physicians should focus on the previously expressed wishes of the patient rather than on the patient's current quality of life or on the wishes of the patient's family.
Prevention of arterial reocclusion after thrombolysis with recombinant lipoprotein-associated coagulation inhibitor BACKGROUND. This study was designed to determine whether arterial reocclusion after thrombolysis can be prevented by lipoprotein-associated coagulation inhibitor (LACI), a physiological inhibitor of tissue factor-induced coagulation mediated by the extrinsic pathway. METHODS AND RESULTS. Thrombosis was induced in femoral arteries of anesthetized dogs with the use of anodal current to elicit extensive vascular injury and formation of platelet-rich thrombi in one artery and with thrombogenic copper wire to elicit fibrin-rich thrombi without appreciable vascular injury in the contralateral artery. Recanalization of both vessels was induced with t-PA (1.7 mg/kg i.v. over 1 hour) and verified with Doppler flow probes. Reocclusion occurred within 2 hours in seven of seven arteries with electrical injury-induced thrombosis and in four of seven arteries with copper wire-induced thrombosis in the absence of LACI. In dogs given infusions of recombinant DNA-produced LACI (225 micrograms/kg over 15 minutes, followed by 4 micrograms/kg/min i.v.) after completion of the infusion of t-PA, no reocclusion occurred during the 2-hour interval of observation in any of the five arteries subjected to electrical injury (p less than 0.001), and cyclic partial occlusions were nearly abolished (0.4 +/- 0.4/hr in LACI-treated dogs compared with 13.7 +/- 5.5/hr in saline-treated dogs, p less than 0.0001). In contrast, reocclusion occurred in two of five arteries with indwelling copper wires, and cyclic partial occlusions were unaffected despite LACI. LACI prolonged the partial thromboplastin time modestly (1.7 +/- 0.2 x baseline) but did not affect platelet counts or aggregation assessed ex vivo. CONCLUSIONS. Inhibition of the extrinsic pathway of coagulation with LACI prevents thrombotic arterial reocclusion after thrombolysis in vessels subjected to extensive vascular injury. Our results demonstrate that activation of the extrinsic pathway plays a critical role in thrombotic reocclusion and that LACI provides a highly targeted approach to facilitate sustained recanalization without directly inhibiting platelets.
Heterosexual transmission of hepatitis delta virus in the general population of an area endemic for hepatitis B virus infection: a prospective study. A prospective study was conducted in 268 consecutive patients with overt hepatitis to examine the transmission of hepatitis delta virus (HDV) in the general population of an area hyperendemic for hepatitis B virus (HBV) infection. The patients were interviewed extensively for potential risk factors associated with transmission. Of the 203 patients with type B hepatitis, 34 (30 men, 4 women) showed serologic evidence of acute HDV infection (HDV+ group), while the other 169 did not (HDV- group). Of the 30 HDV+ men, 27 (90%) had had sexual intercourse with prostitutes within 3 months of admission, while only 31 (22.7%) of the 136 HDV- men, 8 (17.4%) of the 46 men with non-A, non-B hepatitis and 5 (8.3%) of the 60 control men had done so (P less than .001). Of the 4 HDV+ women, 1 was a prostitute and another was the wife of a patient with active HDV infection. There was no significant difference in exposure to other risk factors among these groups of patients. The results suggest that heterosexual exposure, particularly prostitute contact, is the most important route of HDV transmission in the general population of this area endemic for HBV infection.
Portal-systemic encephalopathy: presence of basal ganglia lesions with high signal intensity on MR images. Sixteen patients with cirrhosis of the liver underwent cranial magnetic resonance (MR) imaging and transarterial portography to evaluate the relationship between basal ganglia lesions and portal-systemic collateral vessels. No neuropsychiatric disturbance was observed in any of the patients at the time of the MR examination, but four patients with portal-systemic encephalopathy were included in the study. Basal ganglia lesions, characterized by increased signal intensity on T1-weighted MR images, were observed in nine of the 16 patients, including the four with portal-systemic encephalopathy. These nine patients had large portal-systemic collateral vessels that were more than 10 mm in diameter. These collateral vessels were receiving blood from the superior mesenteric vein (SMV) in all nine patients. The lesions involved the globus pallidus and portions of internal capsules in a bilateral and symmetric fashion and did not exhibit mass effect. The authors conclude that there may be a significant relationship between high-intensity basal ganglia lesions and large portal-systemic collateral vessels receiving blood from the SMV.
Bladder substitution with ileocaecal (Mainz) pouch. Clinical performance over 2 years. A series of 11 patients underwent ileocaecal bladder substitution (Mainz pouch) with urethral anastomosis after radical cystectomy and pelvic lymphadenectomy for moderate to high grade transitional cell carcinoma of the bladder. With 12 to 27 months of follow-up (mean 18), 6 patients are voiding and are dry day and night with timed voidings; 4 patients continue intermittent catheterisation because of inability to perform the Valsalva manoeuvre adequately, and 1 has a suprapubic tube because of stricture of the enterourethral anastomosis. Upper tract studies revealed dilation of 4 of 22 renal units and 1 patient required endourological intervention. Serum electrolyte studies revealed slightly elevated chloride levels in 6, mild hypocarbia in 3, and reduced vitamin B12 levels in all patients, but no megaloblastic anaemia. The Mainz pouch appears to have very satisfactory short- and intermediate-term results.
Preoperative and postoperative adjuvant chemotherapy using CISCA (cyclophosphamide, doxorubicin, and cisplatin) in the treatment of invasive transitional-cell carcinoma of the bladder. Fifteen patients with invasive (T2-T4) transitional-cell carcinoma of the bladder were scheduled for three courses of CISCA followed by radical cystectomy and two additional courses of CISCA. Seven patients completed the entire protocol, and 13 completed all the preoperative courses. Seven of 13 patients demonstrated downstaging of their cancers. Of these patients, one has died, one is alive with disease, and five are free of disease at 7 to 38 (mean 17) months. Of the six patients without downstaging, one survives free of disease at 42 months and one is alive with disease 12 months after cystectomy. Downstaging appears to be an important prognostic indicator. Additional studies are being conducted to determine if neoadjuvant chemotherapy improves long-term survival.
CD4+ T cell clones specific for the human p97 melanoma-associated antigen can eradicate pulmonary metastases from a murine tumor expressing the p97 antigen. p97 is a human tumor-associated Ag present on most melanoma cells that represents a possible target for immunologic attack. To evaluate the capacity of T cells reactive with this protein to promote elimination of melanoma cells expressing p97, a murine model was developed by transfecting a C3H/HeN melanoma with the p97 cDNA, generating p97-specific CD4+ T cells by in vivo immunization of C3H/HeN mice with a vaccinia/p97 recombinant virus followed by in vitro cloning with soluble p97 protein, and determining whether these CD4+ T cells could mediate rejection of pulmonary metastases. Characterization of the T cell clones demonstrated the presence of both I-Ak and I-Ek-restricted clones, although the majority of clones recognized p97 in the context of I-Ek. Analysis of clonal specificity using truncated p97 proteins revealed that at least three epitopes were immunogenic, and further studies with overlapping 15-amino acid peptides from a region of the p97 molecule defined by these truncated proteins identified an immunodominant epitope responsible for the majority of the I-Ek response. The T cell clones were not capable of directly recognizing the p97-expressing melanoma cells but responded to the tumor if syngeneic APC were present to process the tumor-derived p97 Ag. The therapeutic efficacy of these CD4+ T cell clones was evaluated in an adoptive therapy model in which mice bearing metastatic pulmonary lesions were treated by i.v. administration of the p97-specific cells. Despite the inability of the CD4+ clones to directly respond to or lyse the tumor cells, the clones were effective in promoting tumor eradication. In vitro studies demonstrated that this may have reflected secretion of lymphokines that activated macrophages to lyse the tumor. The results suggest that noncytolytic p97-specific CD4+ T cell clones can be effective in therapy of pulmonary melanoma metastases. Moreover, if human T cells reactive with the p97 protein could be generated, the expression of this tumor-associated Ag in melanoma cells might be adequate for such T cells to mediate a therapeutic antitumor response.
Facial nerve regeneration through autologous nerve grafts: a clinical and experimental study. Human facial nerve regeneration was compared in two systems: autologous neural cable grafts (N = 56) and direct end-to-end anastomosis (N = 34). The data were analyzed based on the following criteria: facial symmetry and muscle tone at rest, degree of total facial reinnervation, voluntary motion, synkinesis, and electrophysiologic testing. Facial tone and symmetry at rest, and electrophysiologic tests were similar, while voluntary motion and facial reinnervation were decreased and synkinesis increased in the autologous cable graft repairs. Electrophysiologic tests failed to distinguish between the two repair methods in successful regenerates. Neural cable grafts were associated with more mass movement and less fine precise emotive facial movement. Excellent cable graft repair results diminish with time because of continual progressive synkinesis, which may take up to 4 years to develop. Eight-millimeter neural cable graft repairs of the buccal division of the facial nerve in rabbits (N = 8) demonstrate, at 5 weeks, equal myelinated and more unmyelinated axons than in the normal nerve controls. Neural cable graft repairs demonstrate two features not found in the normal nerve: 1. myelin debris and 2. two subpopulations of axons--extrafascicular and intrafascicular. Myelin debris predisposes towards extrafascicular axon regeneration. Extrafascicular axons are the major neurite regenerates (63%). Intrafascicular axons are the major reinnervators of the distal transected nerve stump. Electrophysiologic studies demonstrate decreased conduction velocities which are related to the number and size of myelinated axonal regenerates. The implications for neurite reinnervation of the autologous cable graft and their role in synkinesis are discussed.
Morbidity and vaginal tubal cautery: a report and review. Vaginal tubal sterilization was once the procedure of choice for interval sterilization. This technique fell out of favor in part because of a perceived increase in morbidity over the evolving laparoscopic techniques. Complications should be minimized by the advent of routine antibiotic prophylaxis and improved operating techniques that allow shorter procedure times. We retrospectively reviewed 240 vaginal tubal sterilization procedures performed by a single physician. Long-term follow-up (more than 5 years) was available in over half the study group (52%). Half of all operations were completed in 12 minutes or less, with an average time of 14.5 minutes. The planned vaginal procedure was completed in all but two cases, both of which required laparotomy secondary to dense adhesions. Median estimated blood loss was 20 mL. No postoperative infection was encountered. These data suggest that vaginal tubal sterilization may still be a safe alternative for interval sterilization.
Role of endogenous endothelin in the development of hypertension in rats. To further elucidate the pathophysiologic role of endogenous endothelin (ET), we have studied the chronic effect of anti-ET gamma-globulin on the development of hypertension in spontaneously hypertensive rats (SHR) and stroke prone SHR (SHR-SP) for three weeks. In neither SHR nor SHR-SP did repetitive bolus injection of anti-ET gamma-globulin suppress the rise in blood pressure. The present data suggest that endogenous ET is not likely to play a key role in the development of hypertension, although ET may induce a local vasoconstriction at the injured vascular wall.
Intracortical osteosarcoma. A case report. Intracortical osteosarcoma (IO) is the rarest form of osteosarcoma. A 19-year-old man had one of these lesions in the upper diaphysis of the femur. Microscopically, IO was a well-differentiated osteosarcoma with an osteoblastic histologic pattern. The typical location in the diaphysis and the peculiar histologic and roentgenographic findings with intracortical origin clearly separate this entity from conventional osteosarcomas as well as periosteal and parosteal osteosarcomas. IO are lytic neoplasms confined to the cortex of the diaphysis with a benign roentgenographic appearance, but are included in the differential diagnosis of benign tumors.
Surveillance alone versus radiotherapy after orchiectomy for clinical stage I nonseminomatous testicular cancer. Danish Testicular Cancer Study Group. From December 1980 to January 1984, all patients with stage I nonseminomatous testicular cancer in Denmark entered a randomized trial comparing surveillance only with radiotherapy after orchiectomy. One hundred fifty patients were assessable for the final analysis. Relapse occurred in 23 patients in the surveillance group and in 11 patients in the radiotherapy group. Radiotherapy completely prevented retroperitoneal relapse; 14 retroperitoneal relapses occurred in the surveillance-only group. All relapsing patients in the surveillance-only group are without evidence of disease with a median observation time after chemotherapy of 67 months. Two of the patients with relapse in the radiotherapy group died with disease; the others are alive without evidence of disease, with a median observation time after relapse treatment of 72 months. In the surveillance group, four relapses occurred later than 2 years after orchiectomy; only one such late relapse occurred in the radiotherapy group. Four of the retroperitoneal relapses occurred without concomitant increase in the serum marker levels (alpha-fetoprotein [AFP] and human chorionic gonadotropin [HCG]). It is concluded that surveillance only should replace radiotherapy after orchiectomy as standard treatment for clinical stage I nonseminomatous testicular cancer. Improved methods for control of retroperitoneal relapses, especially of embryonal carcinomas, are needed.
Export of intracellular HBsAg in chronic hepatitis B virus infection is related to viral replication. Serum and liver HBsAg bear an inverse relation to each other during the evolution of chronic hepatitis B virus infection and the quantity of HBsAg in tissue rises gradually with time. In this study, intracellular and extracellular levels of HBsAg were measured by radioimmunoassay in primary culture of hepatocytes from 30 patients with chronic hepatitis B virus infection to determine a possible relationship with hepatitis B virus replication. Serum levels of HBsAg correlated with markers of active viral replication (serum hepatitis B virus DNA, p less than 0.005, and tissue HBcAg, p less than 0.02) but inversely with tissue HBsAg (p less than 0.05). In similar fashion, in vitro export of HBsAg was also related to the presence of active viral replication markers (serum hepatitis B virus DNA, p less than 0.02, and tissue HBcAg, p less than 0.05) and negatively with tissue HBsAg (p less than 0.001). Export of HBeAg also correlated positively with markers of active viral replication (serum hepatitis B virus DNA, p less than 0.05 and tissue HBcAg, p less than 0.05). Further experiments indicated that intrahepatic pre-S1 and pre-S2 correlated closely with intrahepatic HBsAg, indicating that a failure to export HBsAg was unlikely to be attributable to deficient intracellular expression of pre-S1 or pre-S2. These data indicate that in vitro primary hepatocyte culture of hepatitis B virus-infected cells provides an accurate reflection of in vivo export of HBsAg and that this is closely related to the presence of active viral replication.