shukoor65/lab-rag-model huggingface dataset:
Long-term follow-up after sustained monomorphic ventricular tachycardia: Causes, pump failure, and empiric antiarrhythmic therapy that modify survival. We analyzed the actuarial cardiac mortality rate of 295 consecutive patients with sustained monomorphic ventricular tachycardia who were referred to us between 1978 and 1988. Patients were divided into four groups: group I of 156 patients with coronary disease, group II of 55 patients with nonischemic left ventricular disease, group III of 65 patients with right ventricular disease, and group IV of 19 patients without detectable heart disease. Patients were treated empirically according to a prospective schema: (1) class I antiarrhythmic drugs, (2) in case of recurrence of ventricular tachycardia: amiodarone or beta-blockers, (3) in case of recurrence of ventricular tachycardia: drug combinations or surgery. The mean follow-up duration was 61 +/- 40 months after the first occurrence of ventricular tachycardia, and the clinical outcome was known in 67.5% of patients at 5 years. The actuarial mortality rates were considerably higher in groups I and II compared with those in groups III and IV (p less than 0.01). The mortality rate was slightly higher in group I than in group II (p less than 0.05). In groups I and II, actuarial mortality rate were much higher when left ventricular ejection fraction was less than 0.30 (p less than 0.01). Comparisons between treatments showed no difference in actuarial mortality rates in patients with ventricular tachycardia and left ventricular ejection fraction greater than 0.30.
WT1 mutations contribute to abnormal genital system development and hereditary Wilms' tumour. Wilms' tumour (WT), aniridia, genitourinary abnormalities and mental retardation form a symptom group (WAGR syndrome) associated with hemizygous deletions of DNA in chromosome band 11p13 (refs 1,2). However, it has not been clear whether hemizygosity at a single locus contributes to more than one phenotype. The tumour suppressor gene for Wilms' tumour, WT1, has been characterized: it is expressed at high levels in the glomeruli of the kidney, as well as the gonadal ridge of the developing gonad, the Sertoli cells of the testis and the epithelial and granulosa cells of the ovary, suggesting a developmental role in the genital system in addition to the kidney. We now report constitutional mutations within the WT1 genes of two individuals with a combination of WT and genital abnormalities as evidence of a role for a recessive oncogene in mammalian development.
The detection of hepatitis B virus (HBV) in HBsAG negative individuals with primary liver cancer. The importance of chronic hepatitis B virus (HBV) infection in the development of primary liver cancer has been established by epidemiological studies. However, the evidence for a direct role of the virus in liver carcinogenesis is still tentative. In addition, the findings of HBV DNA sequences in HBsAg-negative subjects with liver cancer has been reported, although it is controversial. Here we report the use of the polymerase chain reaction to detect HBV DNA in the serum and liver of HBsAg-negative patients. This technique allows both for the detection and cloning of HBV variants. In addition, the demonstration of HBV DNA and RNA molecules in HCC of HBsAg-negative individuals as determined by standard techniques reinforces the role of HBV in the pathogenesis of this tumor.
Mycotic aortic aneurysm infected by Clostridium septicum--a case history. The authors describe a sixty-seven-year-old hypertensive, diabetic man with a mycotic abdominal aortic aneurysm infected with Clostridium septicum. The patient had colonic polyps but no malignant disease. They could find only one other report of a mycotic aneurysm infected with C. septicum. In that case, as in most other cases of C. septicum bacteremia, the patient had gastrointestinal cancer. Their case suggests that treatment for a clostridial infection should be considered in patients with known gastrointestinal disease, signs and symptoms of sepsis, and abdominal pain. Conversely, patients known to have a C. septicum infection should be evaluated for gastrointestinal lesions.
Hormonal and local factors in hypertension. The cause of primary (essential) hypertension remains unknown, but a number of circulating hormones and endothelium-derived factors are probably involved. This review summarizes recent evidence on the roles of hyperinsulinemia, the renin-angiotensin system, atrial natriuretic factor, and three endothelium-derived factors--prostacyclin, endothelium-derived relaxing factor, and endothelin.
Cauda equina compression associated with breast cancer. A case study in differential diagnosis. The determination of the etiology of spinal cord compression in cancer patients is essential for appropriate therapy. Patients with metastatic disease are not immune to the development of superimposed nonmalignant disease. Although metastatic epidural compression may occur in up to 9% of breast cancer patients, care must be taken to rule out other nonmetastatic lesions causing compression. The association of concurrent breast carcinoma and a spinal neurilemoma simulating a metastatic lesion seems not to have been previously reported. A neurilemoma was observed in a 50-year-old woman. A neurilemoma suspected to be a metastatic lesion may produce the clinical features of pain, neurologic deficit, and weakness. Differentiation will be aided by roentgenograms, radionuclide bone scans, computed tomography, and possible magnetic resonance imaging. Radiologic differentiation hinges on the recognition and the slow-growing nature and noninvasive boundaries of the nonmalignant lesion. Ultimate verification is by biopsy. Treatment should consist of neurectomy, if severely symptomatic, and stabilization as indicated.
Invasive cervical carcinoma: MR imaging after preoperative chemotherapy. To evaluate assessment of tumor regression with magnetic resonance (MR) imaging, the authors studied 21 consecutive patients with cervical carcinoma tumors that were more than 3 cm in diameter. Thirteen of the 21 also demonstrated parametrial invasion. In all cases, MR imaging was performed both before and after chemotherapy. Pathologic specimens were obtained at hysterectomy in all patients. Comparison of pathologic and MR imaging findings after chemotherapy showed that all tumors decreased in size. Size of tumor was correctly determined at MR in 17 cases and was slightly overestimated in four cases. Five patients had residual parametrial invasion that was histologically confirmed. In detecting parametrial spread after treatment, MR imaging had an accuracy of 90.4%. Tumors had high signal intensity on T2-weighted images, whereas intratumoral necrosis was characterized by low signal intensity on the same images. Peritumoral inflammatory tissue found at pathologic examination in four of 21 cases was not specifically identified on MR images. In patients with invasive cervical carcinoma, MR imaging may be useful in evaluating tumor response to preoperative chemotherapy.
Calves as a source of an outbreak of cryptosporidiosis among young children in an agricultural closed community. Transmission of Cryptosporidium from animals to humans, originating mainly in calves, had been suggested previously but has remained unproved. An outbreak of cryptosporidiosis that started among calves was transmitted to multiple pediatric groups living in close contact through one family who had close contact with the calves. Eleven of 19 (58%) infants and young children ages 10 to 15 months had Cryptosporidium compared with 3 of 27 (11%) of those ages 36 to 60 months and none of those ages 16 to 35 months. None of the asymptomatic children was positive for Cryptosporidium. These data emphasize that an extensive human to human transmission does not rule out the zoonotic nature of cryptosporidiosis.
Clofazimine: a review of its use in leprosy and Mycobacterium avium complex infection. This article reviews the chemistry, pharmacology, spectrum of activity, pharmacokinetics, clinical efficacy in leprosy and Mycobacterium avium complex (MAC) infection, adverse effects, drug interactions, and special considerations of clofazimine. The drug is active in vivo against M. leprae and in vitro against MAC. In addition, it possesses antiinflammatory and immunosuppressive properties. Clinical studies support the efficacy of clofazimine as a part of multidrug therapy in treating leprosy. It also appears to reduce the incidence and severity of erythema nodosum leprosum reactions that often occur during the treatment of leprosy. Efficacy in treating MAC infection in patients with AIDS is not well documented, despite the use of clofazimine in combination with other agents. A few patients have responded symptomatically and by clearing their mycobacteremia, although there is no evidence that mortality is reduced. Clofazimine is well tolerated, at least when doses less than or equal to 100 mg/d are used. Adverse reactions include discoloration of the skin, self-limiting gastrointestinal intolerance, severe and life-threatening abdominal pain and organ damage due to clofazimine crystal deposition, and asymptomatic discoloration of the eye. Clofazimine should be considered for formulary inclusion.
Intraoperative radiotherapy of skull base cancer. As the head and neck surgeon expands the boundaries of resectability into the skull base, the margin of tumor clearance diminishes. Intraoperative radiotherapy (IORT) can be used as an adjunct to skull base surgery and external beam radiation to enhance local control in areas with close margins or remaining microscopic disease. During the period from May 1982 to May 1988, 25 patients underwent IORT of the skull base following resection and prior to closure to treat microscopic disease in 9 patients, sterilize close margins in 14 patients, and attempt to eliminate remaining gross disease in 2 patients. The types of tumors treated were 13 squamous cell carcinomas, 4 adenoid cystic carcinomas, 3 high-grade mucoepidermoid carcinomas, 3 sarcomas, 1 malignant mixed tumor, and an oncocytic adenocarcinoma. The majority of the tumors either originated in the sinuses or were skull base extensions of oral cavity or oropharyngeal cancers. In 22 patients with 1-year follow-up, IORT prevented local recurrence in 14 (64%) patients. This may represent improved control of local disease in patients who historically have a very dismal prognosis. The indications, techniques, and complications of this exciting therapeutic modality are also reviewed.
Prevention of postoperative renal dysfunction in patients with obstructive jaundice: a multicentre study of bile salts and lactulose. The role of preoperative lactulose and bile salts in the prevention of postoperative renal failure in patients with obstructive jaundice has been evaluated in a prospective randomized trial. One hundred and two patients undergoing surgery for obstructive jaundice (bilirubin greater than 100 mumols/l) were randomized into three groups: those receiving preoperative oral lactulose (n = 35), those receiving oral sodium deoxycholate (n = 32) and a control group of patients receiving no specific treatment (n = 35). All patients received intravenous fluids commencing the night before surgery. One patient in the control group and none in the treatment groups developed postoperative renal failure. Postoperative deterioration of renal function in patients with normal preoperative function was significantly more common in the control group than in the treatment groups (chi 2 = 8.1, d.f. = 2, P less than 0.02). The incidence of renal failure and impairment was lower in this control group than that reported in previous studies. This may be due to the introduction of adequate preoperative hydration. Additional protection occurs by the preoperative administration of either lactulose or sodium deoxycholate.
Nonepileptic events in childhood. The medical records of 27 children admitted to the MINCEP Epilepsy Program for evaluation of intractable epilepsy but later shown to have nonepileptic events by EEG with simultaneous video monitoring were reviewed. Four groups were identified: pure psychogenic events (5 patients), psychogenic events plus epileptic seizures (3 patients), pure nonepileptic physiologic events (5 patients), and nonepileptic physiologic events plus seizures (14 patients). Historical data, physical examinations, and neurodiagnostic evaluations (including previous EEGs, neuroradiologic evaluations, and neuropsychologic testing) were reviewed. Children in all groups, except for those with pure psychogenic seizures, had a history of multiple seizure types identified by parents or caretakers. A history of status epilepticus was obtained in 64% (of 22 patients), including 11 of 14 patients with physiologic events plus seizures. Abnormal findings on neurologic examination were common, especially in children with nonepileptic physiologic events. All but two patients had a history of interictal epileptiform abnormalities on previous routine EEGs. Based on identification of nonepileptic events, antiepileptic drugs (AEDs) were discontinued completely in eight patients (30%) and the total number of AEDs was reduced in nine others (33%). A diagnosis of nonepileptic events should be considered in all children with refractory seizures or multiple seizure types. Abnormal findings on routine (interictal) EEG may actually confound the diagnosis. Intensive neurodiagnostic EEG-video recording is the preferred method for distinguishing nonepileptic from epileptic seizures.
Cardiovascular effects of bupropion in depressed patients with heart disease. OBJECTIVE: The cardiovascular effects of therapeutic plasma levels of tricyclic antidepressants in depressed patients with and without preexisting cardiac disease have been well characterized and include orthostatic hypotension and conduction delay. Bupropion, structurally unrelated to tricyclic antidepressants, is relatively free of cardiac side effects in depressed patients without cardiac disease. However, it is unknown whether bupropion is safe for depressed patients with preexisting heart disease, so the authors studied the cardiovascular effects of bupropion in such patients. METHOD: The subjects were 36 inpatients with DSM-III major depression and preexisting left ventricular impairment (N = 15), ventricular arrhythmias (N = 15), and/or conduction disease (N = 21). The patients continued their cardiac drug regimens and received bupropion for 3 weeks (mean +/- SD dose = 442 +/- 47 mg/day). Cardiovascular functioning was measured by pulse, blood pressure, high-speed ECG, 24-hour portable ECG, and radionuclide angiography. RESULTS: Although bupropion caused a rise in supine blood pressure, it did not cause significant conduction complications, did not exacerbate ventricular arrhythmias, had a low rate of orthostatic hypotension, and had no effect on pulse rate. However, bupropion treatment was discontinued for 14% of the patients because of adverse effects, including exacerbation of baseline hypertension in two patients. CONCLUSIONS: The cardiovascular profile of bupropion may make this drug a useful agent in the treatment of the depressed patient with preexisting cardiovascular disease. Further studies, with longer durations of bupropion treatment and more subjects, are needed to confirm these findings.
Hemolytic reactions to nitrofurantoin in patients with glucose-6-phosphate dehydrogenase deficiency: theory and practice. The prescribing information for nitrofurantoin states that patients with glucose-6-phosphate dehydrogenase deficiency may experience hemolysis following administration of the drug. Although there is no doubt that this statement is qualitatively correct, the degree of risk in the general population of patients has not been previously quantified. This study was designed to estimate the degree of risk of a clinically important hemolytic reaction to nitrofurantoin by means of a retrospective analysis of the Norwich Eaton adverse reaction database. Since 1953, approximately 130 million courses of nitrofurantoin therapy have been distributed in the U.S. alone. The database contained 127 reports of hemolytic reactions; a "worst-case" estimate of the incidence rate was 1 in 100,000 courses of therapy. Considering the extensive usage of nitrofurantoin, clinically important hemolytic reactions appeared to be very rare. For the cases in which outcome was recorded, complete recovery occurred in 87 percent of patients. Although nitrofurantoin is contraindicated after the onset of labor and in infants less than one month old, no well-documented cases of hemolytic reactions in neonates were identified.
Current issues in the performance of Mohs micrographic surgery. Recently, a survey was sent to all members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology concerning their performance of Mohs micrographic surgery. Responses to numerous questions regarding the daily practice of this technique revealed that many useful modifications have evolved over the years that serve to enhance the efficacy and the efficiency of the original Mohs surgical procedure. The results of this survey are presented and discussed.
Ewing's sarcoma: metastatic tumor to the jaw. Metastatic tumors to the jaw are a rare occurrence. The incidence of metastatic Ewing's sarcoma to the jaw has been reported to be less than 2% of all cases of Ewing's sarcoma. Early detection of such lesions is difficult because the signs and symptoms do not appear until the lesion has progressed considerably. The treatment options are therefore limited to palliative care of the patient rather than cure. This article reports a case of Ewing's sarcoma that had metastasized to the mandible and reviews the literature.
Non-neoplastic pineal cysts. We identified 53 patients with non-neoplastic cysts of the pineal gland. In contrast to patients with pineal neoplasms, pineal cysts are usually asymptomatic. They infrequently obstruct the aqueduct to cause hydrocephalus or compress the tectum to produce the neuro-ophthalmologic signs of dorsal midbrain dysfunction. Obstructive hydrocephalus was present in only five patients (9.4%); three of them showed clinical signs of Parinaud's syndrome. CT and MRI typically reveal a cystic mass that averages 1.6 cm in anteroposterior (A-P) diameter with calcification at the periphery and faint rim-like contrast enhancement. Sagittal MRI is the most useful diagnostic test because it shows the anatomic relationship of the cyst to the aqueduct. The mass may compress the tectum and distort the proximal aqueduct; occasionally a large cyst may occlude the aqueduct. All patients with obstructive hydrocephalus had cysts greater than 2.0 cm in A-P diameter. Nine patients had suboccipital craniotomy. In all of them, the cysts contained clear fluid and were easily removed. We advocate conservative management with clinical observation of these benign lesions that may be developmental variants of normal pineal gland.
Imipenem/cilastatin treatment of bacterial meningitis in children. The safety and efficacy of imipenem/cilastatin were evaluated in 21 children, ages 3 to 48 months, with bacterial meningitis. Eradication of bacteria from the cerebrospinal fluid was demonstrated within 24 hours of antibiotic therapy in all but 2 patients who had Haemophilus influenzae type b meningitis and ultimately achieved bacteriologic cure after 2 to 3 days of imipenem/cilastatin therapy. Cerebrospinal fluid penetrations of imipenem and cilastatin were determined at various times after drug administration with mean cerebrospinal fluid: serum ratios of 14 and 10% for imipenem and cilastatin, respectively. The study was terminated when 7 (33%) patients developed seizure activity after antibiotic therapy was administered. The usefulness of imipenem/cilastatin for the treatment of bacterial meningitis in children may be limited by a possible increased incidence of drug-related seizure activity.
Reversal of benzodiazepine sedation with the antagonist flumazenil. The effectiveness of the benzodiazepine antagonist, flumazenil, was evaluated in a randomized double-blind clinical study in which diazepam 0.2 mg kg-1 or midazolam 0.1 mg kg-1 was used for i.v. sedation. We studied 120 day-case patients undergoing gastroscopy and treated with either flumazenil 0.1-2 mg or placebo after the procedure. Psychometric assessment of four aspects of recovery over a 3-h period showed that flumazenil attenuated the sedative effects of the benzodiazepines, but did not antagonize the sedation completely. For patients sedated with diazepam, there was a significant effect of flumazenil on speed of motor co-ordination after 90 min (P less than 0.01), and for those given midazolam a similar effect was found at 20 min (P less than 0.01). However, after 3 h all four groups of patients had not returned to baseline performance in accuracy of motor co-ordination (P less than 0.01) and cortical arousal (P less than 0.05), and the two groups sedated with diazepam still displayed memory deficits (P less than 0.05). Flumazenil did not attenuate the subjective experience of sedation as measured by visual analogue scales. These results indicate that sedation is multidimensional, differentially affecting the hierarchy of cognitive functions. In day-cases, antagonism of benzodiazepine sedation with flumazenil would not hasten the safe discharge of patients.
Laceration of the left pulmonary artery during removal of a bronchogenic cyst by right thoracotomy. Major vascular involvement by a bronchogenic cyst is rare; most large cysts cause respiratory symptoms. We present a case in which a large bronchogenic cyst was adherent to the left pulmonary artery. During removal of the cyst by right thoracotomy, the artery lacerated. Repair of the artery in such a situation taxes the surgeon's ingenuity and decision-making process.
Facilitated referral to asthma specialist reduces relapses in asthma emergency room visits. Facilitated asthma-specialist care delivered by allergists was compared to generalist care on the rate of relapse of asthma emergency room (ER) visits and hospitalizations and on asthma control in a prospective, controlled study of San Diego Kaiser Health Plan members with asthma. Subjects with asthma between the ages of 6 and 59 years presenting for acute ER care for asthma were systematically assigned by alternating, consecutively, the day of their ER visit to receive either (1) facilitated referral to an asthma specialist within the allergy department and concomitant comprehensive ongoing asthma care (intervention group, n = 149) or (2) continued outpatient management from generalist physicians (control group, n = 160). The course of their asthma was evaluated blindly during the subsequent 6 months by review of medical records, initial and follow-up questionnaires, and spirometry. Compared to the control group, the intervention group noted (1) a 75% reduction in the number of, and percent of, subjects with asthma awakenings per night (p less than or equal to 0.0001), (2) an almost 50% reduction in asthma ER relapses (p = 0.017) resulting from a reduction in the frequency of multiple relapse (p = 0.005), and (3) a greater use of inhaled corticosteroids (p less than 0.00001) and cromolyn (p = 0.002). Thus, facilitated referral of subjects with asthma to specialists in asthma therapy after acute ER therapy appears to reduce asthma ER relapses and to improve asthma outcome.