shukoor65/lab-rag-model huggingface dataset:
Mortality among workers exposed to ethylene oxide. BACKGROUND. Ethylene oxide is a sterilant gas that causes leukemia and other cancers in animals. Studies in Sweden have shown an excess of leukemia and stomach cancer in humans exposed to ethylene oxide, but other studies have generally failed to confirm these findings. METHODS. We conducted a study of mortality in 18,254 U.S. workers exposed to ethylene oxide at 14 plants producing sterilized medical supplies and spices. The subjects averaged 4.9 years of exposure to the gas and 16 years of follow-up. The exposure levels in recent years averaged 4.3 ppm (eight-hour time-weighted adjusted exposure) for sterilizer operators and 2.0 ppm for other workers. The levels in earlier years are likely to have been several times higher. Mortality in this cohort was compared with that in the general U.S. population. RESULTS. Overall there was no significant increase in mortality from any cause in the study cohort. The standardized mortality ratios (SMRs) were 0.97 for leukemia (95 percent confidence interval, 0.52 to 1.67; 13 deaths observed), 1.06 for all hematopoietic cancers (95 percent confidence interval, 0.75 to 1.47; 36 deaths), and 0.94 for stomach cancer (95 percent confidence interval, 0.45 to 1.70; 11 deaths). Analyses according to job category and according to the duration of exposure showed no excess in cancers, as compared with the rate in the general population, but there was a significant trend toward increased mortality with increasing lengths of time since the first exposure for all hematopoietic cancers. The rate of death from hematopoietic cancer (especially non-Hodgkin's lymphoma) was significantly increased among men (SMR, 1.55; 27 deaths). Mortality from leukemia in recent years (1985 through 1987) was significantly increased among men (SMR, 3.45; 5 deaths). CONCLUSIONS. For the entire cohort, there was no increase in mortality from hematopoietic cancer. There was a slight but significant increase among men, however. Among men and women combined, there was a trend toward an increased risk of death from hematopoietic cancer with increasing lengths of time since the first exposure to ethylene oxide.
Propranolol ameliorates the development of portal-systemic shunting in a chronic murine schistosomiasis model of portal hypertension. We investigated the role of early portal hypotensive pharmacotherapy in preventing the development of portal-systemic shunting in a portal hypertensive model of chronic murine schistosomiasis induced by infecting C3H mice with 60 cercariae of Schistosoma mansoni. Propranolol was administered in drinking water to 20 animals for a period of 6 wk at a dose of 10 mg.kg-1d-1, starting at 5 wk of schistosomal infection. 32 age-matched mice with chronic schistosomal infection served as controls. All animals were studied 11 wk after the infection. Compared with controls the portal pressure (10.8 +/- 0.40 mmHg) was significantly lower (P less than 0.001) in the propranolol-treated animals (7.9 +/- 0.80 mmHg). Portal-systemic shunting was decreased by 79%, from 12.2 +/- 3.34% in controls to 2.5 +/- 0.99% in the propranolol group (P less than 0.05). Portal venous inflow was reduced by 38% in the propranolol treated animals (2.50 +/- 0.73 ml/min; n = 6) compared with controls (4.00 +/- 0.34 ml/min; n = 8; P less than 0.05). The worm burden, the granulomatous reaction, the collagen content of the liver, and the serum bile acid levels were not significantly different between the two groups of animals. These results demonstrate that in chronic liver disease induced by schistosomiasis, the development of portal-systemic shunting can be decreased or prevented by the reduction of flow and pressure in the portal system.
Prevention of bacterial infection in neutropenic patients with hematologic malignancies. A randomized, multicenter trial comparing norfloxacin with ciprofloxacin. The GIMEMA Infection Program. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto. OBJECTIVE: To compare the efficacy of norfloxacin and ciprofloxacin in preventing bacterial infection in neutropenic patients. DESIGN: A randomized, controlled, multicenter trial. SETTING: Twenty-one hematologic units in tertiary care or university hospitals. PATIENTS: Eight hundred and one consecutive, afebrile, adult patients who had hematologic malignancies or who had bone marrow transplantation and chemotherapy-induced neutropenia (neutrophil count, less than 1000/mm3) expected to last more than 10 days. INTERVENTION: Patients were randomly assigned to receive orally every 12 hours norfloxacin, 400 mg, or ciprofloxacin, 500 mg. MEASUREMENTS: Efficacy analysis was done for 619 patients: 319 treated with norfloxacin and 300 treated with ciprofloxacin. MAIN RESULTS: More patients receiving ciprofloxacin did not develop fever during neutropenia and did not receive antibiotics (34%) compared with those receiving norfloxacin (25%) (P = 0.01). Patients receiving ciprofloxacin had a lower rate of microbiologically documented infection (17% compared with 24%; P = 0.058), particularly of infection from gram-negative bacilli (4% compared with 9%; P = 0.03). The interval to the first febrile episode was also longer in patients receiving ciprofloxacin (8.3 compared with 7.2 days; P = 0.055). The rates of clinically documented infection, fever of unknown origin, and mortality as well as compliance and tolerability were similar in the two groups. Patients who had neutropenia for less than 15 days, who had severe neutropenia for less than 7 days, and who received antifungal prophylaxis benefited most from ciprofloxacin therapy. CONCLUSION: Ciprofloxacin should be used to prevent the development of infection in neutropenic patients with hematologic malignancies.
Adjuvant whole-abdominal radiation therapy in uterine papillary serous carcinoma. Nine patients from 34 to 74 years of age (median, 67 years of age) with uterine papillary serous carcinoma (UPSC) were treated with whole-abdominal radiation therapy (WART) on an adjuvant basis after cytoreductive surgery. All patients were treated with megavoltage photons to an abdominopelvic field to a median dose of 2500 cGy, with continued treatment to a whole pelvic field to a median dose of 4500 cGy. Three patients received additional boost to the vaginal apex. Follow-up time ranged from 6 to 31 months (median, 25 months) after completion of WART. Six patients had recurrent disease at 5 to 20 months (median, 7.5 months). Four of these patients died of their disease during the follow-up period. Three of six patients in whom treatment failed had disease at the vaginal apex. None of these patients received boost radiation therapy to that site. In contrast, two of three patients remaining disease free were treated with additional vaginal apex irradiation. Based on these results, the authors do not routinely recommend WART for adjuvant treatment of UPSC. They do, however, recommend vaginal apex irradiation for these patients.
Increased plasma endothelin-1 in the early hours of acute myocardial infarction. Endothelin is a novel endothelium-derived vasoactive peptide with potent vasoconstrictor action in the coronary bed; however, its possible contribution to myocardial ischemia and infarction is not known. Plasma endothelin-1 concentration was measured with use of a radioimmunoassay in serial venous samples from 22 patients over a 72 h period after acute myocardial infarction (14 patients with uncomplicated infarction [group I] and 8 patients with hemodynamic or ischemic sequelae [group II]). Twenty-two normal subjects and seven patients with stable angina served as the control subjects. Endothelin-1 levels in patients with stable coronary disease were not different from those of normal subjects (0.62 +/- 0.56 and 0.76 +/- 0.38 pg/ml, respectively). In group I, plasma levels of endothelin-1 rose sharply after myocardial infarction, reaching a peak of 4.95 +/- 0.78 pg/ml at 6 h after the onset of chest pain (p less than 0.05 compared with values in control subjects) and returning rapidly toward the normal range by 24 h. Patients with complicated infarction (group II) demonstrated a similar rapid increase in plasma endothelin-1 to a peak value of 8.29 +/- 1.95 pg/ml; however, plasma endothelin-1 remained elevated in these patients, becoming significantly different from values in group I at 48 and 72 h. There was no correlation between peak increases in creatine kinase and peak endothelin-1 in either group, suggesting that the stimulus for elevation of endothelin-1 was not myocardial necrosis itself. Furthermore, left ventricular ejection fraction did not correlate with the increase in endothelin-1 in group I patients, whereas there was a significant inverse relation between ventricular function and plasma endothelin-1 in group II.
Legionella myositis. Neuromuscular involvement in patients with legionnaires' disease is common, with serum CK elevations in up to 78% of patients. A few cases have been associated with neuropathy. The mechanism of injury to the neuromuscular system is unknown, but organisms have not previously been found in nerve or muscle. We report the clinical, electrophysiologic, and pathologic findings in a patient with Legionella myositis and motor neuropathy, the first case to demonstrate direct muscle invasion by the Legionella organism.
Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature. Plantar fasciitis is a common orthopedic syndrome among athletes and nonathletes. The etiology of the pain is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. The majority of patients will respond to conservative measures. Surgical treatment is reserved for those patients who do not respond. A complete plantar fascia release is performed through a medial longitudinal incision. Prominent heel spurs and degenerated areas in the plantar fascia are resected. Of 27 surgically treated cases followed from one to three years, satisfactory results were obtained in 24 cases. Histologically, localized fibrosis or granulomatous changes or both were noted in several cases.
Creatine kinase isoenzyme band mimicking CK MB on agarose gel electrophoresis. The authors report the case of an 80-year-old man with prostatic disease whose serum contained an aberrant band in the MB position on agarose gel electrophoresis of creatine kinase (CK) isoenzymes. The authors demonstrated that the band probably was CK BB; the patient had no evidence of myocardial infarction. Contrary to most previous reports of such cases, the aberrant enzyme did not appear to be linked with IgG, IgA, or IgM; it also did not behave as if attached to a chelatable cation. Care must be taken to avoid mistaking such bands for CK MB.
Does cigarette smoking have an independent effect on coronary heart disease incidence in the elderly? In order to evaluate the effects of cigarette smoking on coronary heart disease (CHD) in elderly persons in the Honolulu Heart Program, 1,394 men between ages 65 and 74 were followed during an average 12-year period for new cases of nonfatal myocardial infarction and fatal CHD. Incidence rates increased progressively in individuals classified at baseline as never, former, and current smokers, respectively. The absolute excess risk associated with cigarette smoking was nearly twice as high in elderly compared with middle-aged men.
Muscle mitochondrial DNA in encephalomyopathy and ragged red fibres: a Southern blot analysis and literature review. Various mitochondrial DNA abnormalities have been described in patients with encephalomyopathies. We performed Southern blot analysis of skeletal muscle mitochondrial DNA in nine adult patients with clinical features and ragged red fibres suggesting mitochondrial dysfunction. Two patients with encephalomyopathy and two with the MERRF syndrome (myoclonus epilepsy with ragged red fibres) had the normal PvuII restriction pattern of muscle mitochondrial DNA. In contrast, mitochondrial DNA deletion was observed in two of six patients with ophthalmoplegia. One suffered from typical Kearns-Sayre syndrome and the other from isolated external ophthalmoplegia. None of these patients had affected relatives. The detection of mitochondrial DNA deletion in external ophthalmoplegia and their site and size support previously reported data.
Acute positive inotropic intervention: the phosphodiesterase inhibitors. Phosphodiesterase inhibitors that are selective for cAMP-specific cardiac and vascular PDE III comprise a new group of agents for the treatment of heart failure, which at present are limited to clinical shortterm intravenous use and research uses only. Although both intravenous amrinone and milrinone are FDA approved, only amrinone is available for general clinical use. Selective phosphodiesterase inhibition produces beneficial actions of positive inotropy and peripheral vasodilation that result from increased cardiac and vascular muscle concentrations of intracellular cAMP and ionic calcium. In addition, a positive lusitropic action (enhancement of cardiac relaxation) has been observed. Neither beta-adrenergic agonist activity nor inhibition of the sodium-potassium ATPase is produced by these agents. The magnitude of hemodynamic improvement generally exceeds that of the cardiac glycosides and is comparable with that of intravenous catecholamines such as dobutamine. The different pharmacodynamic profile of the PDE inhibitors is additive to the effects of cardiac glycosides, complementary and synergistic to the actions of catecholamines, and has been shown to have favorable effects on coronary hemodynamics. As a result there is continued enthusiasm for the short-term intravenous use of amrinone and potentially milrinone in the setting of acute heart failure resulting from systolic dysfunction (after myocardial infarction, open heart surgery, or infectious or toxic myocarditis), heart failure resulting from right ventricular systolic dysfunction, and when patients with severe heart failure await cardiac transplantation. Initiation of treatment with an intravenous bolus followed by a maintenance infusion provides prompt increases in stroke volume and cardiac output and simultaneous reductions in right and left ventricular filling pressures and systemic vascular resistance.
Consequences of the nuclear power plant accident at Chernobyl [published erratum appears in Public Health Rep 1991 May-Jun;106(3):352] The Chernobyl Nuclear Power Plant accident, in the Ukrainian Soviet Socialist Republic (SSR), on April 26, 1986, was the first major nuclear power plant accident that resulted in a large-scale fire and subsequent explosions, immediate and delayed deaths of plant operators and emergency service workers, and the radioactive contamination of a significant land area. The release of radioactive material, over a 10-day period, resulted in millions of Soviets, and other Europeans, being exposed to measurable levels of radioactive fallout. Because of the effects of wind and rain, the radioactive nuclide fallout distribution patterns are not well defined, though they appear to be focused in three contiguous Soviet Republics: the Ukrainian SSR, the Byelorussian SSR, and the Russian Soviet Federated Socialist Republic. Further, because of the many radioactive nuclides (krypton, xenon, cesium, iodine, strontium, plutonium) released by the prolonged fires at Chernobyl, the long-term medical, psychological, social, and economic effects will require careful and prolonged study. Specifically, studies on the medical (leukemia, cancers, thyroid disease) and psychological (reactive depressions, post-traumatic stress disorders, family disorganization) consequences of continued low dose radiation exposure in the affected villages and towns need to be conducted so that a coherent, comprehensive, community-oriented plan may evolve that will not cause those already affected any additional harm and confusion.
Spontaneous near disappearance of bilateral coronary artery-pulmonary artery fistulas. Although coronary artery fistula is a relatively rare anomaly, it sometimes develops with advancing age, requiring surgical removal. We report a unique case of a patient whose bilateral coronary artery-pulmonary artery fistulas nearly disappeared in the course of four years. This case is interesting in view of recognizing one of the natural courses of this entity.
Cerebral blood flow changes in migraine: methods, observations and hypotheses. A number of basically different methods have been used in studies of the cerebrovascular changes which occur in migraine and each individual set of findings seems to be dependent on which method is used. One method on its own can only disclose a part of all the pathophysiological events. This review is an attempt to consider the capabilities of each method and to bring together the results from different studies on migraine in order to create a complete picture of the cerebrovascular changes which occur during the course of a migraine attack.
Pulmonary oedema after airway obstruction due to bilateral vocal cord paralysis. We report a case of pulmonary oedema which developed after airway obstruction due to bilateral vocal cord paralysis. The patient was a 52-yr-old woman undergoing craniotomy for an acoustic neuroma. Anaesthesia was uneventful. Spontaneous ventilation resumed after reversal of neuromuscular blockade. Following extubation she showed signs of airway obstruction and dyspnoea. The trachea was reintubated but she became hypoxic, PaO2-36 mmHg, produced pink frothy secretions and the x-ray was typical of pulmonary oedema. The oedema cleared within 24 hr. Tracheostomy was performed one week later as the cords were still fixed, but the latter had recovered by three months and the tracheostomy was closed. The cause of the cord paralysis is unknown but probably was a result of surgical trauma to the brain stem.
Progression of coronary atherosclerosis: is coronary spasm related to progression? A total of 239 patients undergoing serial coronary angiography with a concomitant ergonovine provocation test were studied between July 1974 and June 1987. The progression of coronary artery disease was evaluated in relation to risk factors, especially coronary artery spasm. Patients were classified into three groups: 1) new myocardial infarction group (39 patients); 2) progression without infarction group (90 patients); and 3) nonprogression group (110 patients). To assess how risk factors and coronary spasm are related to the occurrence of new myocardial infarction and progression without infarction, 11 variables in the three groups were examined: age, gender, the time interval between the studies, fasting blood sugar, systolic blood pressure, diastolic blood pressure, smoking, serum cholesterol, triglyceride, uric acid and a positive response to the ergonovine provocation test. Multiple regression analysis selected three independent predictors of progression without infarction: cholesterol (p less than 0.01), systolic blood pressure (p less than 0.05) and a positive response to the ergonovine provocation test (p less than 0.001). Multiple regression analysis also selected three independent predictors of the occurrence of new myocardial infarction: fasting blood sugar (p less than 0.01), systolic blood pressure (p less than 0.05) and a positive response to the ergonovine provocation test (p less than 0.001). A positive response to the ergonovine provocation test was the strongest factor for occurrence of both new myocardial infarction and progression without infarction. To evaluate segmental arterial changes, 3,275 coronary artery segments were analyzed in the 239 patients.
Reductions in cirrhosis deaths in the United States: associations with per capita consumption and AA membership. Cirrhosis mortality and morbidity rates have declined in many jurisdictions, including the U.S., in recent years. Previous research in Canada and Europe suggests that these declines are linked to changes in per capita consumption of alcohol and changes in the availability and/or utilization of services to reduce abusive drinking (e.g., treatment, Alcoholics Anonymous). In this study, changes in cirrhosis death rates in the 50 U.S. states and the District of Columbia between 1974 and 1983 were regressed onto changes in per capita consumption (1974-83). AA membership (1974-83) and alcoholism treatment (1979-82). No significant relationship between treatment and cirrhosis changes was observed; however, the measure of change in treatment may not reflect the full extent of changes that occurred in the 1974-83 period. As predicted, decreases in per capita consumption and increases in AA membership were significantly associated with decreases in cirrhosis rates.
Severe, symptomatic, dose-limiting hypophosphatemia induced by hepatic arterial infusion of recombinant tumor necrosis factor in patients with liver metastases. Twenty-two patients with liver metastases received 45 courses of recombinant tumor necrosis factor (rTNF) by hepatic arterial infusion in doses ranging from 12.5 to 175 micrograms/m2/d for 5 days by continuous infusion. The induction of statistically significant, dose-related, severe, albeit transient, hypophosphatemia (less than 1.0 mg/dl) associated with clinically significant, right-sided myocardial dysfunction and severe lassitude was observed. These side effects were promptly reversed after rTNF was stopped and intravenous phosphate supplementation was started. As no significant or consistent increase in urinary phosphate excretion was detected, the rTNF-induced hypophosphatemia probably resulted from an intracellular shift of phosphate. Since tumor regression was clearly associated with the lowest levels of serum phosphate, hypophosphatemia may be important in the antitumor effects of rTNF.
Psammomatous melanotic schwannoma: an additional component of Carney's complex. Report of a case. The authors report a case of Carney's complex (the complex of myxomas, spotty pigmentation, and endocrine overactivity) in a 32-year-old white man. Psammomatous melanotic schwannoma has recently been included as a component of this disorder. The complex was recognized after a psammomatous melanotic schwannoma was resected from the sacral canal. Subsequent echocardiography revealed ventricular cardiac myxomata. Resection of these lesions was successfully performed. Review of previous history and pathologic material further supported the diagnosis. The authors conclude that recognition of each component as part of the syndrome is of crucial importance, because it may prevent a fatal outcome. A family screening program should be performed in each case.
Effect of interferon administration on serum hepatitis C virus RNA in patients with chronic hepatitis C. Hepatitis C virus RNA as detected by reverse transcription and nested polymerase chain reaction was monitored in 16 patients with chronic hepatitis C treated with interferon. Hepatitis C virus RNA became undetectable after 4 to 8 wk of interferon administration in 13 of the 16 patients. During 6 mo of follow-up, 5 of the 13 patients who became negative for hepatitis C virus RNA after interferon administration remained negative, and all five continued to have normal ALT levels. Repeat liver biopsy in these five patients revealed histological improvement. Antibody to hepatitis C virus, which was initially positive in all treated patients, fell to undetectable levels in three of the five patients. In contrast, aminotransferase levels rose again in all eight patients who had become hepatitis C virus RNA negative but had again exhibited hepatitis C virus RNA after completion of therapy. In 16 untreated patients, hepatitis C virus RNA remained detectable. These results indicate that detection of hepatitis C virus RNA may be useful as a marker of viral replication in chronic hepatitis C; they also suggest that interferon should again be administered to patients who become hepatitis C virus RNA negative on treatment but again exhibit this marker of viral replication when treatment is stopped.