shukoor65/lab-rag-model huggingface dataset:
Outcome in children who nearly drown: a British Isles study OBJECTIVE--To determine the outcome in nearly drowned children in the British Isles and identify factors that might predict a poor prognosis. DESIGN--Study of drowned and of nearly drowned children aged less than or equal to 14. Information on nearly drowned children admitted to hospital obtained from consultant paediatricians returning monthly notification cards through the British Paediatric Surveillance Unit. Information on drowned children obtained from Office of Population Censuses and Surveys and other national epidemiological offices. SETTING--British Isles, 1988 and 1989. SUBJECTS--330 children who had confirmed submersion incidents. 142 died before admission to hospital and 188 children were admitted after nearly drowning. MAIN OUTCOME MEASURES--Death, full recovery, or degree of handicap after near drowning and signs on admission to hospital. RESULTS--All of the children who were conscious on admission fully recovered. Of the 64 children unconscious on admission, 31 had normally reactive pupils and all but three (all of whom had severe preexisting neurological disease) recovered fully. Of the 33 children with fixed dilated pupils on admission, 10 fully recovered, 13 died, and 10 had severe neurological deficit. Spontaneous respiratory effect on admission was associated with normal survival. Pupils that remained dilated six hours after admission and fits continuing 24 hours after admission predicted a poor outcome. CONCLUSION--Children can survive normally after near drowning in the British Isles, particularly if they have been hypothermic. Resuscitation should not be abandoned in nearly drowned children until they have been rewarmed.
Increasing breast cancer screening among the medically underserved--Dade County, Florida, September 1987-March 1991. Efforts to detect breast cancer at early stages are critical in reducing breast cancer-associated mortality. However, in the United States, different barriers (e.g., lack of insurance, limited access to medical care, and limited awareness of the importance of early diagnosis and treatment) prevent certain groups from using early detection services. To promote early detection of breast cancer among an estimated 67,000 medically underserved women aged greater than or equal to 40 years, the Early Detection Program (EDP) was begun in Dade County, Florida, in the fall of 1987 (1). This report summarizes the progress of the program for September 1987 through March 1991.
Inner ear damage secondary to diabetes mellitus. I. Changes in adolescent SHR/N-cp rats. The association between diabetes mellitus and hearing impairment has been debated in many previous studies. The spontaneous hypertensive/NIH-corpulent (SHR/N-cp) rat has been shown to be a unique genetic model for non-insulin-dependent diabetes mellitus. Seventeen diabetic and 17 control young male rats were divided into groups according to diet and phenotype. The rats were fed either 54% of sucrose or 54% starch diets for 3.5 months and killed at 5 months. The cochleas were fixed, decalcified, dissected, and stained for hair cell counting. A significant loss of outer hair cells was noted in the diabetic obese (SHR/N-cp) animals when compared with the control obese (LA/N-cp) animals in every group. Although no significant difference was noted between the diabetic obese (SHR/N-cp) animals receiving the starch and sugar diets, the diabetic obese (SHR/N-cp) animals were more severely affected than the nondiabetic lean (SHR/N-cp) rats.
Cortical benzodiazepine receptor binding in patients with generalized and partial epilepsy. Impaired cortical inhibition may be involved in epileptogenic mechanisms. In a positron-emission tomography (PET) study, we demonstrated a reduction of the cortical benzodiazepine (BZD) receptor density in the epileptic foci of patients with partial epileptic seizures. In the present study, we used the same method in 10 patients with primary generalized epilepsy to determine whether an altered BZD receptor binding could also be demonstrated in this patient group. The [11C]-labeled BZD receptor antagonist Ro 15-1788 was used as ligand. Receptor affinities and densities were calculated in various cortical regions and then compared with the values from corresponding "nonepileptic" regions in the previously examined partial epilepsy patients. Focal alterations of the BZD receptor density or affinity were not demonstrated in patients with generalized epilepsy. This patient group had a slight tendency toward lower mean cortical BZD receptor density, however, as compared with corresponding values from 10 patients with partial epilepsy. Our results strongly suggest that a focal alteration of cortical inhibition is not a prominent feature of human generalized epilepsy. The observed tendency toward lower mean cortical BZD receptor density may be a consequence of diffusely impaired cortical inhibition. Further investigations of this issue are therefore indicated.
Synthesis and evaluation of new iodine-125 radiopharmaceuticals as potential tracers for malignant melanoma. The synthesis, labeling, and biodistribution of four 125I radiopharmaceuticals designed to localize in melanoma were tested. Uptake in tumors was demonstrated by autoradiography of whole-body sections and quantitated by measurement of radioactivity of selected tissues and tumors using melanoma-bearing mice. N-(2-diethylaminoethyl)-4-iodobenzamide was selected for its highest melanoma uptake: 60 min after IV injection of 6.5% and 4% ID/g, respectively for murine B16 and human melanotic melanoma. Tumor uptake showed the highest values of all analyzed tissues from 6 to 24 hr after injection. High uptake in melanotic tumor tissue with relatively low uptake in blood, muscle, brain, lung, and liver tissue resulted in high tumor/nontumor ratios (at 24 hr for B16, tumor/blood = 37, tumor/brain = 147, tumor/muscle = 95). This agent was compared with iodoamphetamine. Scintigraphic images of the tumor confirmed that external detection of melanoma is possible with this new radiopharmaceutical.
Dissecting aneurysms of the posterior inferior cerebellar artery. The authors present three cases of dissecting aneurysms of the posterior inferior cerebellar artery (PICA). A literature search revealed only three previous cases. Analysis of these six cases showed a unique clinical picture. Three patients developed subarachnoid hemorrhage, and the other three had ischemia. All patients complained of occipital headache or neck pain, regardless of the initial symptoms. Heralding episodes were recorded in four cases. Angiography showed a characteristic fusiform dilatation of the PICA and a narrowing proximal to and distal to the lesion. Various surgical treatments were performed in five cases. Intraoperative observation showed a sausage-like swelling of the PICA or one of its branches with various discoloration depending on the age of the intramural clot. The outcomes were favorable.
Stromal osseous metaplasia in carcinoma of the bladder. Osseous metaplasia of the stroma of carcinomas of the bladder is a rare finding that must be distinguished from osteosarcoma and carcinosarcoma. We report a case of multifocal osseous metaplasia in a high grade urothelial carcinoma with extensive glandular differentiation, arising in the base of the bladder of an 84-year-old man. Reports of 11 other cases of stromal osseous metaplasia in primary bladder carcinomas and of 5 cases of stromal osseous metaplasia in metastases of bladder carcinoma are reviewed.
Effects of interferon-gamma therapy on thyroid function, T-lymphocyte subpopulations and induction of autoantibodies. Treatment with human leucocyte interferon (IFN alpha) has been associated with the development of thyroid autoimmunity and hypothyroidism, but it is not certain whether this phenomenon was a result of contamination with IFN gamma, which induced HLA class II antigen expression on T-lymphocytes. We prospectively studied 11 subjects (5 females and 6 males; mean age, 26.8 yr; range, 18-36) with chronic active hepatitis B who were randomized to receive recombinant human IFN gamma (rhIFN gamma; 10(6) U/m2.day, im, 3 times/week) for 16 weeks. Goiter was not present, and no patient had a history or family history of autoimmune diseases. Serial thyroid functions, including serum T4, T3, free thyroid hormone index, free T4 and TSH before, during, and on subsequent follow-up for a period of 1 yr were all normal. Eight patients had adequate serial samples for study of serological and lymphocyte subpopulations. None of the patients treated with rhIFN gamma developed thyroglobulin or thyroid microsomal antibodies. However, four patients developed antinuclear and smooth muscle autoantibodies during or after rhIFN gamma treatment. Treatment with rhIFN gamma resulted in a significant increase in circulating T-lymphocytes and HLA-DR-positive T-cells (P less than 0.05), with equal proportions of circulating CD4+ and CD8+ T-cells becoming DR positive. The percentage of HLA-DR-positive T-cells remained elevated after discontinuation of rhIFN gamma. Also, rhIFN gamma treatment led to a decrease in the number of circulating granulocytes and interleukin-2 receptor-positive cells. In conclusion, we did not observe any thyroid dysfunction or thyroid autoimmunity in our patients treated with the studied dose of rhIFN gamma, but induction of other autoantibodies was observed.
The effect of an extra-articular procedure on allograft reconstructions for chronic ruptures of the anterior cruciate ligament. A study was performed on the effect of the addition of an extra-articular procedure involving tenodesis of the iliotibial band to a reconstruction with a bone-patellar ligament-bone allograft for the treatment of chronic rupture of the anterior cruciate ligament. One hundred and four patients were divided into two groups for comparison: Group 1 (sixty-four patients) was treated with only an intra-articular replacement with an allograft and Group 2 (forty patients), with both an intra-articular replacement with an allograft and the extra-articular procedure. Preoperatively, there were no statistically significant differences between the two groups in terms of twenty variables, including body weight, level of activity, anterior-posterior displacements, number of previous operations, and duration of follow-up. All of the patients returned for follow-up evaluation twenty-three to fifty-four months (mean, thirty-five months) postoperatively. All were treated with the same postoperative program of immediate motion of the knee and rehabilitation. The results were evaluated with the use of a comprehensive subjective and objective system that rated the twenty factors. Both procedures proved to be effective in decreasing functional limitations and symptoms and in improving the level of sports activity and the over-all scores. The results in Group 2 were significantly better than those in Group 1, as measured with tests done with the KT-1000 arthrometer (p less than 0.01) and with regard to the level of sports activity (p less than 0.05) and the over-all scores (p less than 0.01). There was no postoperative difference between the two groups in terms of the results on pivot-shift or isokinetic testing, patellofemoral crepitus, functional limitations, or symptoms. The program of rehabilitation effectively restored 0 to 135 degrees of motion to all but four knees, which lacked 5 degrees of extension at the most recent follow-up. The over-all rate of failure for both groups was 11 per cent. However, the rate of failure was 16 per cent (ten of sixty-four knees) in Group 1 and only 3 per cent (one of forty knees) in Group 2. This difference was significant (p less than 0.05). The extra-articular procedure appeared to provide support to the healing intra-articular allograft by reducing deleterious forces and tibial displacements, and to restore the secondary restraints provided by the lateral iliotibial band. The results suggest that the combination of the procedures is of value in young, athletically active people who have chronic rupture of the anterior cruciate ligament.(ABSTRACT TRUNCATED AT 400 WORDS).
Nasal administration of salmon calcitonin for prevention of glucocorticoid-induced osteoporosis in children with nephrosis. To determine the effect of intranasal administration of salmon calcitonin on glucocorticoid-induced osteoporosis in children with nephrosis, we gave 100 U of calcitonin intranasally on alternate days with 1 alpha-hydroxyvitamin D3 to five children, 8 to 12 years of age, with frequently relapsing nephrosis. Four patients with osteoporosis, 10 to 14 years of age, were treated only with 1 alpha-hydroxyvitamin D3 and served as control subjects. Both groups were treated with an almost equal amount of glucocorticoids previously and during this study period. Bone mineral content of the spine was measured by a quantitative computed tomographic technique. The bone mineral content was preserved in both cortical and spongeous areas of the vertebrae during the 16-month period in the calcitonin-treated group but was decreased significantly in the control group. Urinary hydroxyproline and calcium excretion decreased significantly in the calcitonin-treated group. The serum calcium and phosphorus concentrations and the parathyroid function did not change significantly in either group. We conclude that calcitonin suppressed bone resorption and might be useful for the long-term treatment of osteoporosis, in combination with 1 alpha-hydroxyvitamin D3, in children with nephrosis requiring long-term glucocorticoid therapy.
Adrenergic regulation of (Na+, K+)-ATPase activity in proximal tubules of spontaneously hypertensive rats. Increased renal nerve activity and sodium retention have been implicated in the development of hypertension in genetically transmitted forms of this disease. The present studies were designed to investigate the relationship between renal nerve integrity and renal proximal tubule (Na+, K+)-ATPase activity in spontaneously hypertensive rats (SHR). (Na+, K+)-ATPase activity of basolateral membranes (BLMs) enriched from proximal tubules of five-week-old SHR was greater, 328.6 +/- 18.9 nmol Pi/mg protein.min, than in age-matched genetic controls rats (Wistar-Kyoto, WKY, rats), 262.3 +/- 34.6 nmol Pi/mg protein.min (P less than 0.02). There was no detectable difference in (Na+, K+)-ATPase activity of 13-week-old SHR and WKY rats. Prior renal denervation was associated with a reduction in proximal tubule basolateral membrane (BLM) (Na+, K+)-ATPase activity, 316.8 +/- 23.8 to 223.1 +/- 23.9 nmol Pi/mg protein/min (P less than 0.02), in five-week SHR. However, denervation had no effect on renal (Na+, K+)-ATPase activity in either WKY rats, nor did sham-denervation in SHR. In addition, exogenous norepinephrine, 1 microM, produced a more pronounced stimulation of (Na+, K+)-ATPase activity in basolateral membranes from SHR as opposed to WKY controls (40.2% vs. 28.7%). Therefore, renal nerve integrity and exogenous catecholamines have a greater stimulatory influence on proximal tubule (Na+, K+)-ATPase activity in the early stages (prior to 5 weeks) of the development of hypertension in SHR than in age-matched WKY rats.
Plasma levels of plasminogen activator inhibitor type 1, beta-thromboglobulin, and fibrinopeptide A before, during, and after treatment of acute myocardial infarction with alteplase. Plasma levels of plasminogen activator inhibitor type-1 (PAI-1), beta-thromboglobulin (beta TG), and fibrinopeptide A (FPA) were followed over 24 hours in 30 patients treated with alteplase for acute myocardial infarction. Samples were taken at baseline (T Oh), after 90 minutes (under alteplase, no heparin, T 1.5h), after 120 minutes (under alteplase and heparin, T 2h), 30 minutes after thrombolytic therapy (T 3.5h), as well as 12 hours (T 12h) and 24 hours (T 24h) after baseline. PAI-1 antigen levels (55 +/- 9 ng/mL at T Oh, mean +/- SEM) decreased to 35 +/- 5 (T 1.5h) and 40 +/- 6 (T 2h) ng/mL under alteplase, before increasing to 84 +/- 22 (T 3.5h), 130 +/- 30 (T 12h), and 64 +/- 7 (T 24h) ng/mL after therapy, P less than .001. A high baseline PAI-1 activity (18 +/- 3 ng/mL) decreased to 2.0 +/- 0.4 (T 1.5h) and 1.7 +/- 0.2 (T 2h) under alteplase and increased to 32 +/- 5 (T 12h) and 19 +/- 3 (T 24h) ng/mL after therapy (P less than .0001). beta TG levels (339 +/- 105 ng/mL at T Oh) decreased to 203 +/- 48 (T 2h), 154 +/- 51 (T 3.5h), 187 +/- 40 (T 12h), and 142 +/- 32 (T 24h) ng/mL under heparin (P less than .01). FPA levels (34 +/- 9 ng/mL at T Oh) increased to 85 +/- 15 ng/mL under alteplase alone (T 1.5h) and normalized under heparin (11 +/- 4, 6 +/- 2, 4 +/- 2, and 3 +/- 1 ng/mL at T 2h, T 3.5h, T 12h, and T 24h, respectively). A high level of FPA at T 3.5h correlated with reocclusion (33 +/- 12 ng/mL, n = 4 v 2.9 +/- 0.5 ng/mL, n = 21, P less than .005). We conclude that plasma levels of PAI-1 antigen as well as activity markedly increase after alteplase therapy of acute myocardial infarction. The high activity of PAI-1 and decreasing beta TG levels suggest that platelets do not contribute significantly to this phenomenon. The marked increase of FPA levels under recombinant tissue-type plasminogen activator alone and its normalization under heparin emphasize the important role of concomitant anticoagulation in controlling further intravasal fibrin generation under alteplase.
Coupling between the heart and arterial system in heart failure. A number of experimental studies have demonstrated the optimal coupling between the ventricle and arterial load, under physiologic and pathologic circumstances, directed to produce maximal stroke work. We investigated matching of the ventricular properties, quantified by the slope of end-systolic pressure-volume relationship, with arterial load properties, expressed by the slope of end-systolic pressure-stroke volume relationship. In normal subjects, with ejection fraction of greater than or equal to 60%, ventricular elastance was nearly twice as large as arterial elastance. This condition affords maximal mechanical efficiency. In patients with moderate heart failure, with ejection fraction of 40-59%, ventricular elastance was almost equal to arterial elastance. This condition affords maximal stroke work from a given end-diastolic volume. In patients with severe heart failure, with ejection fraction of less than 40%, ventricular elastance was less than half of arterial elastance, which resulted in increased potential energy and decreased work efficiency. Ventriculoarterial coupling is normally set toward higher left ventricular work efficiency, whereas in patients with moderate cardiac dysfunction, ventricular and arterial properties are matched, in order to maximize stroke work at the expense of work efficiency. Neither the stroke work nor work efficiency is near maximum for patients with severe cardiac dysfunction.
Nutrition and metabolism in sepsis and multisystem organ failure. Sepsis and organ failure produce profound metabolic changes that contribute to hepatic and musculoskeletal failure. When multiple organ failure develops, the mortality rate is high, and therapy is unlikely to be effective unless the causative process (e.g., infection, low cardiac output) can be eliminated. Thus, the prevention of multiple organ failure and the prevention or early treatment of infection are paramount. Organ and nutritional support to prevent complications is necessary. The gastrointestinal tract should be used for nutrition whenever possible with a blenderized regular diet with fiber, glutamine, and short-chain fatty acids to protect and preserve the gut. If parenteral nutrition is necessary, special solutions may be necessary for the liver, kidneys, or lungs. If not, protein with 45% branched-chain amino acid, medium- and short-chain triglycerides, glutamine supplementation, and carbohydrates seem best. Other substances are being evaluated that may be helpful in nutrition and organ support, including arginine, xylitol, growth hormone, and anabolic steroids. Multiple organ failure should be prevented, if at all possible, by stopping or controlling the injury, removing as much necrotic tissue as possible, improving blood flow and oxygen consumption, supporting metabolism, and preventing infection or treating it early and adequately. Nutritional support plays a key role in preventing metabolic failure.
Staple closure of the hypopharynx after diverticulectomy and total laryngectomy. The use of stapling devices to close hypopharyngeal defects was first published in 1969 but the technique does not seem to have gained much popularity among head and neck surgeons. Fifty-nine hypopharyngeal defects were closed using a linear stapler between January, 1984, and April, 1989, at the Department of Otolaryngology, Head and Neck Surgery of the University Hospital of Zurich. Twenty closures were performed following resection of hypopharyngeal diverticula, 39 following wide field laryngectomy. A total of 10 salivary fistulae was observed: 2 after diverticulectomy (10%), 3 after laryngectomy in nonirradiated patients (11%), and 5 after laryngectomy in irradiated patients (45%). These fistula rates are comparable with average rates quoted in the literature. Only after laryngectomy for radiation failure was the fistula rate unusually high. No other complications were seen that could have been attributed to this type of pharyngeal closure. Closure of a hypopharyngeal defect with a stapler is easier and faster than with traditional suture methods. Provided the patient has not been previously irradiated, staple closure of the hypopharynx appears to be as reliable as closure by standard techniques and can be safely recommended.
Role for tumor necrosis factor as mediator of lung injury following lower torso ischemia. Ischemia and reperfusion of the ischemic lower torso lead to a neutrophil- (PMN) dependent lung injury characterized by PMN sequestration and permeability edema. This mimics the injury seen after infusion of tumor necrosis factor alpha (TNF), a potent activator of PMN and endothelium. This study tests whether TNF is a mediator of the lung injury after lower torso ischemia. Anesthetized rats underwent 4 h of bilateral hindlimb tourniquet ischemia, followed by reperfusion for 10 min, 30 min, 1, 2, 3, and 4 h (n = 6 for each time point). Quantitative lung histology indicated progressive sequestration of PMN in the lungs, 25 +/- 3 (SE) PMN/10 high-power fields (HPF) 10 min after reperfusion vs. 20 +/- 2 PMN/10 HPF in sham animals (NS), increasing to 53 +/- 5 PMN/10 HPF after 4 h vs. 23 +/- 3 PMN/10 HPF in sham animals (P less than 0.01). There was lung permeability, shown by increasing protein accumulation in bronchoalveolar lavage (BAL) fluid, which 4 h after reperfusion was 599 +/- 91 vs. 214 +/- 35 micrograms/ml in sham animals (P less than 0.01). Similarly, there was edema, shown by the lung wet-to-dry weight ratio, which increased by 4 h to 4.70 +/- 0.12 vs. 4.02 +/- 0.17 in sham animals (P less than 0.01). There was generation of leukotriene B4 in BAL fluid (720 +/- 140 vs. 240 +/- 40 pg/ml, P less than 0.01), and in three of six rats tested at this time TNF was detected in plasma, with a mean value of 167 pg/ml. TNF was not detectable in any sham animal.
Anaesthesia for a patient with giant axonal neuropathy. Giant axonal neuropathy is a generalised disorder of cytoplasmic intermediate filaments which particularly involves the peripheral and central nervous systems. In this paper we describe a child with giant axonal neuropathy and discuss the anaesthetic management in the light of the pathology and physiology of the condition.
Jaundice and cholestasis. Some common and uncommon causes. Jaundiced patients may not always be as sick as they look, and cholestatic patients may be quite ill but not yet jaundiced. There is variability in presentation of cholestasis, and jaundice may be intrahepatic or extrahepatic and acute or chronic. Even though the diagnosis of jaundice can be elusive, an unnecessarily exhaustive search for a cause should be avoided, because some tests are not without dangers. Dr Gordon describes many possible causes, some of which are rare but are still worth consideration.