shukoor65/lab-rag-model huggingface dataset:
The place of isradipine in the treatment of hypertension. Isradipine is a new dihydropyridine calcium antagonist with a high degree of selectivity for the coronary, cerebral, and skeletal muscle vasculature. The drug has minimal depressant activity on sinoatrial node automaticity and negligible negative chronotropic, dromotropic, and inotropic actions. Isradipine reduces blood pressure and systemic vascular resistance without changes in cardiac output and stroke volume. Renal blood flow is maintained while renal vascular resistance is reduced; this is accompanied by both short- and long-term diuretic and natriuretic effects. Doses of 1.25 to 5 mg twice daily lowers blood pressure effectively over 24 h. In open as well as placebo-controlled trials, 2.5 to 10 mg isradipine twice daily was safe and well tolerated, and reduced systolic and diastolic values in up to 85% of patients with mild-to-moderate hypertension. Efficacy is similar to those of nifedipine and nitrendipine, and potentially superior to those of propranolol, atenolol, prazosin, hydrochlorothiazide, and diltiazem. The drug can be safely combined with beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and diuretics. Adverse effects are dose-dependent and secondary to arterial vasodilatation, such as headache, flushing, ankle edema, dizziness, palpitations, and tachycardia. At the recommended dose of 2.5 mg twice daily, the total incidence of side effects does not differ from that with placebo. The antiatherosclerotic, antitrophic, and cerebroprotective effects seen in experimental animal models are promising for the drug in the treatment of human hypertension. Isradipine may not only reduce blood pressure, but may also reduce the risk for the consequences of this peril, namely, cerebral stroke and myocardial infarction.
Perianal ulcer in disseminated histoplasmosis. A 65-year-old man with stage I testicular seminoma, treated with surgery and radiation, had fever of unknown origin, adrenal insufficiency, and an isolated perianal ulcer. Tissue diagnosis of disseminated histoplasmosis was established by biopsy of the perianal ulcer, an unusual cutaneous manifestation of the disease. Treatment with amphotericin B resulted in rapid clinical improvement and complete healing of the perianal ulcer.
Adjuncts to thrombolysis for myocardial reperfusion. OBJECTIVE: To discuss adjunctive pharmacologic agents for acute myocardial infarction, to critique their initial effects in clinical trials, and to review their potential for improving the clinical conditions of patients with acute myocardial infarction. DATA SOURCES: Relevant studies reported from January 1985 to December 1990 were identified through a MEDLINE search of the English-language literature and through a manual search of the bibliographies of all identified articles. STUDY SELECTION: Peer-reviewed experimental and clinical studies evaluating the role of pharmacologic adjuncts to thrombolytic therapy in experimental models of coronary occlusion and clinical trials of patients with acute myocardial infarction were selected for review. DATA EXTRACTION AND SYNTHESIS: The data presented were abstracted by the investigators. Differences with a univariate P value of less than 0.05 were considered to be statistically significant. CONCLUSIONS: Current clinical data suggest that adjunctive pharmacologic therapy to thrombolytic agents should include aspirin, at least 160 mg administered as soon as possible after the onset of symptoms; intravenous heparin; and, in selected patients without contraindications, intravenous beta-blockading agents.
Does infant feeding method influence maternal postpartum weight loss? We conducted a retrospective study of 411 women to determine whether a significant relationship existed between method of infant feeding (breast vs bottle) and postpartum weight loss at 6 weeks and 12 months. In addition to method of infant feeding, the variables parity, gravidity, mode of delivery, maternal age, maternal prepregnancy weight, infant sex, and payment status (whether receiving assistance from the Aid to Dependent Children [ADC] program) were studied in terms of their association with weight loss. In general, no consistent relationship was found between method of infant feeding and postpartum weight loss. However, in the ADC group at 6 weeks and in the non-ADC group at 12 months, nonlactating women had lost more weight than had their lactating counterparts, in spite of the theoretical energy deficiency of breast-feeding women. Women who gained more weight during pregnancy consistently lost more weight following delivery, regardless of their prepregnancy weight. These results indicate that infant feeding method was not related to differences in postpartum weight loss between lactating and nonlactating counterparts.
A public health approach to cholesterol. Confronting the 'TV-auto-supermarket society'. Coronary heart disease has been proved to be associated with a "high-risk" diet and with elevated blood cholesterol levels. The National Cholesterol Education Program has embarked on a campaign based on intensive medical treatment of 60 million Americans with high blood cholesterol levels, but the degree of benefit of dietary change or pharmaceutical intervention or both to reduce blood cholesterol values remains a subject of disagreement within the scientific community. Evidence from comparative international studies suggests that to lower coronary heart disease mortality substantially, dietary alterations and general societal changes must be greater than those possible under the National Cholesterol Education Program's approach of physician-centered patient counseling. The nation's priority to prevent coronary heart disease should be a public policy approach, the goal of which is to reduce for the entire population all coronary disease risk factors. In the dietary area, three proposals to reduce the availability of atherogenic foods are the use of warning labels on atherogenic foods, the prohibition of advertising for such high-risk foods, and the imposition of an excise tax on the same foods. We must confront the "TV-auto-supermarket society" that underlies our nation's high rate of coronary heart disease.
Scintillating scotomata associated with internal carotid artery dissection: report of three cases. We report three cases of cervical internal carotid artery (ICA) dissection, which presented with visual symptoms resembling the migraine aura. When prolonged and especially when associated with other neurologic symptoms, such transient and positive visual phenomena can be manifestations of ICA dissection that mimic migraine.
Expression of functional human Epstein-Barr virus/C3d receptor ([CR2] CD21) on insulinoma cell line. Induction of tumor rejection but not diabetes in syngeneic rats. We stably expressed human complement receptor 2 ([CR2] CD21 C3d/Epstein-Barr virus [EBV] receptor) on the rat insulinoma cell line RINm5F with a recombinant retroviral vector. CR2-expressing RINm5F cells secreted 78-33% less insulin than parental cells or cells transduced with an antisense vector and could be infected with high-titer EBV. We tested whether human CR2 expression on RINm5F cells would affect tumorigenesis after transplantation to syngeneic New England Deaconess Hospital rats. Non-CR2-expressing antisense-transduced RINm5F cells rapidly grew tumors and caused hypoglycemia, hyperinsulinemia, and the death of the animals after 15.7 +/- 0.7 days. CR2-expressing RINm5F cells were infiltrated by mononuclear cells at an early stage and eventually caused noninfiltrated tumors and the death of the animals after 33.0 +/- 0.4 days. These tumors were CR2- and are believed to have arisen from a minor CR2- population of tumor cells. The pancreatic islets were histologically normal at all time points. We conclude that expression of a xenoantigen on a rat insulinoma cell line induces an immune response in syngeneic rats but does not result in breakage of tolerance to parental or revertant cells.
Generation of a nested series of interstitial deletions in yeast artificial chromosomes carrying human DNA. We have generated a nested series of interstitial deletions in a fragment of human X chromosome-derived DNA cloned into a yeast artificial chromosome (YAC) vector. A yeast strain carrying the YAC was transformed with a linear recombination substrate containing at one end a sequence that is uniquely represented on the YAC and at the other end a truncated long interspersed repetitive element (LINE 1, or L1). Homologous recombination between the YAC and the input DNA resulted in a nested series of interstitial deletions, the largest of which was 500 kilobases. In combination with terminal deletions that can be generated through homologous recombination, the interstitial deletions are useful for mapping and studying gene structure-function relationships.
Prostate cancer screening in younger men: prostate-specific antigen and public awareness. The American Cancer Society recommends annual digital rectal examination for men over forty years of age. We evaluated 414 men between forty and fifty-nine years of age with a questionnaire, digital rectal examination (DRE), and prostate-specific antigen (PSA) determination. One hundred ninety were forty to forty-nine years old, and 224 were fifty to fifty-nine years old. Four patients in the forty to forty-nine age group had elevated PSA determinations, and 7 had abnormal findings on DRE. Using prostate ultrasound and biopsy, no cases of prostate cancer were diagnosed. Ten patients in the fifty to fifty-nine age group had elevated PSA determinations, and 5 were diagnosed to have prostate cancer. These data suggest that PSA may have utility in detecting cancer in younger men.
Chemical sympathectomy alters the development of hypertension in miniature swine. To determine if the neurotoxin 6-hydroxydopamine could be used to chemically sympathectomize neonatal miniature swine, eight newborn swine were treated with 6-hydroxydopamine beginning on the first day after birth and continuing at regular intervals for the next 6 months. Six littermates served as controls and received vehicle injections. A significant reduction in the pressor response to intravenous tyramine (95%) and in the tissue norepinephrine content of the kidneys, left ventricle, and gastrocnemius muscle (more than 93%) provided evidence for an effective long-term sympathectomy in the 6-hydroxydopamine-treated animals. In addition, the blood pressure response of these young, chemically sympathectomized swine to chronic deoxycorticosterone acetate treatment was evaluated. Mean arterial pressure before deoxycorticosterone was similar in the 6-hydroxydopamine-treated (116 +/- 2 mm Hg) and control (125 +/- 5 mm Hg) groups. One week after deoxycorticosterone, mean arterial pressure had risen significantly by 20-22 mm Hg in both groups. Blood pressure continued to increase in the control group, reaching a value of 163 +/- 6 mm Hg by the third week after treatment. In contrast, mean arterial pressure in the 6-hydroxydopamine group did not increase further during weeks 2 and 3 after deoxycorticosterone. In conclusion, chronic treatment of neonatal swine with 6-hydroxydopamine produced an animal model with an effective, general, peripheral sympathectomy. The significant attenuation of the hypertensive response in these sympathectomized animals lends further support to the hypothesis that an intact sympathetic nervous system is necessary for the full expression of deoxycorticosterone hypertension in miniature swine.
The epidermal basement membrane in basal cell carcinoma: an immunohistochemical study. An immunohistochemical study of basal cell carcinomas of varying histological type, using a panel of antibodies to constituents of the epidermal basement membrane, showed marked deficiencies in the expression of the antigens identified by the antibodies LH7.2, GB3 and G71. There was no correlation between loss of immunoreactivity to these antibodies and the histological features of the tumour.
Vitamin K therapy in severe liver disease. A middle-aged man with parenchymatous liver disease and a decrease in vitamin K-dependent factors was given large doses of intravenous phylloquinone (10 mg/d for 20 days) without improvement in the synthesis of vitamin K-dependent factors. During subsequent liver transplantation, he exsanguinated. Although the exact role of over treatment with phylloquinone in this case is unclear, plasma levels of phylloquinone 300 times normal were attained after 5 days of treatment without effect on factors II, VII, IX, and X. Further therapy with vitamin K was unnecessary.
Primary cutaneous mucormycosis in a healthy young girl. Report of a case caused by Mucor hiemalis Wehmer. We report an unusual case of primary cutaneous mucormycosis caused by Mucor hiemalis Wehmer that occurred in a healthy young girl after an insect bite. The patient had a slowly extending, indurated, erythematous, and scaling eruption on the right cheek. Histologic examination revealed granulomatous dermatitis and characteristic broad, nonseptate, pale-staining hyphae. This is the first report of an infection in a human being caused by Mucor hiemalis Wehmer. The infection was cured with intravenous amphotericin B.
Serum lipid and apolipoprotein levels in non-hypertensive lean NIDDM patients. To determine the possible role of a glycaemic control in lipid metabolism in non-insulin-dependent diabetes mellitus (NIDDM) patients, serum lipid and apolipoprotein levels were measured in well-controlled and poorly controlled lean NIDDM without proteinuria and hypertension. A sample of 96 lean NIDDM patients (body mass index less than 25 kg m-2 in men and less than 27 kg m-2 in women) were divided into two groups: group I, where the HbA1c concentration had been less than 6% for the previous 3 months, and group II, where the HbA1c concentration had been greater than 8% for the previous 3 months. Serum total cholesterol, triglyceride, and HDL-cholesterol levels showed no significant differences between groups I and II. Furthermore, serum levels of apolipoproteins AI, AII, B, CII, CIII, and E did not differ significantly between groups I and II. These results suggest that glycaemic control did not influence lipid metabolism in lean NIDDM patients.
Regional esophageal distribution and clearance of refluxed gastric acid. Regional differences in the esophageal distribution and clearance of refluxed gastric acid was studied in seven asymptomatic volunteers and seven patients with reflux esophagitis. Intraluminal pH was recorded for 3 postprandial hours from the distal, middle, and proximal esophagus on two separate occasions (with subjects in upright and supine positions). With the subjects in a supine position, about half of the acid reflux episodes reached the proximal esophagus in patients as well as in controls. This percentage decreased to 25% in patients and 29% in controls when they were upright. In both groups, the pH drops in the distal esophagus were significantly greater than in the proximal esophagus for both the supine and upright positions. In both patients and controls, a 4-5-fold greater acid exposure occurred in the distal esophagus, than in the proximal esophagus. In both patient and control groups, acid exposure time, as well as the number of reflux episodes in the distal esophagus, were significantly greater than that of the proximal esophagus (P less than 0.05). Spontaneous acid clearance time in the distal esophagus was significantly longer than that of the proximal esophagus in both positions (P less than 0.05) for both subject groups. In conclusion, regional differences exist in the exposure of the esophageal mucosa to refluxed gastric acid. These regional differences are more pronounced when subjects are upright than supine. Regional differences also exist in esophageal acid clearance, with clearance taking longer in the distal esophagus than in the proximal esophagus. The net effect of these phenomena is that acid exposure time in the distal esophagus is greater than that in the remainder of the esophagus.
Bilateral cerebellopontine angle tumors in neurofibromatosis type 2. In a series of over 500 cases of cerebellopontine angle tumors, 19 patients had bilateral neurinomas. Four of these tumors arose from the facial rather than the acoustic nerve. A conservative policy regarding surgery had been adopted in an effort to prevent hearing loss for as long as possible. Nevertheless, all patients operated on in this series are now totally deaf. The results of managing these patients surgically and conservatively are discussed.
Congenital biliary cysts in Indian adults. Only one report of congenital biliary cysts has been described so far from India, and that was in children. We present our experience with 22 adult Indian patients with this condition. The main presenting symptoms were abdominal pain, icterus, and fever, and the classical triad of jaundice, pain, and abdominal mass was seen in only one patient. The mean age of presentation was 25.5 +/- 10.1 yr, and females predominated (82%). Type Ia cysts (fusiform choledochal cyst) were the commonest. Intrahepatic cysts were seen in four patients; three of these were associated with extrahepatic biliary ductal cysts (type IVa). Internal drainage procedures performed elsewhere in six patients were followed by recurrent cholangitis, necessitating excision of the cyst. Hence, the preferred operation for congenital biliary cysts is cyst excision and hepaticojejunostomy.
Post cricoid lymphangioma. A 69-year-old female patient presented with symptoms characteristic of globus pharyngeus and barium swallow examination was normal. Her symptoms persisted and pharyngoscopy was undertaken; a post-cricoid polyp was found and removed. Histological examination revealed this to be a lymphangioma. Histological appearances, pathogenesis and treatment are discussed. The case illustrates that persisting symptoms presenting as globus pharyngeus should be further investigated to exclude rare lesions.
Prevalence of Type A behavior in untreated hypertensive individuals. Type A behavior has been associated with coronary heart disease as well as high cholesterol and smoking, major risk factors for coronary heart disease, but the data indicating a similar association with hypertension are inconsistent. Since past studies have usually based hypertension on a single blood pressure assessment or have often included treated hypertensive patients, this inconsistency is not surprising. The current study compared the prevalence of Type A behavior (assessed by Rosenman's structured interview) between 109 untreated hypertensive subjects and 109 age-, sex-, ethnic-, and occupation-matched normotensive subjects. Hypertension status was based on five repeated assessments over a 5-month period. Results indicated that Type A behavior is more prevalent in untreated, mildly hypertensive employed individuals than occupationally matched normotensive subjects. Type A component analysis confirmed the importance of hostility and certain vigorous voice stylistics in predicting cardiovascular conditions. These findings, taken together with the evidence linking Type A behavior with high cholesterol and cigarette smoking, further support the view that this behavior pattern is associated with increased risk of coronary heart disease.
Implications of obesity for cardiovascular disease in blacks: the CARDIA and ARIC studies [published erratum appears in Am J Clin Nutr 1991 Sep;54(3):590] To examine the relation of obesity to cardiovascular disease in blacks, we analyzed data from two population studies, including young and middle-aged adults. Obesity, defined by using the sum of subscapular and triceps skinfold measurements, was positively associated with atherogenic plasma lipids, systolic blood pressure, serum glucose and insulin, and prevalence of diabetes mellitus. The strength of these associations, for the most part, was similar in blacks and whites. However, with each unit increase in sum of skinfold thicknesses, plasma triglyceride concentrations in blacks appeared to increase only one-third to one-half as much as in whites. Prevalence of cardiovascular disease in 45- to 65-y-old blacks was associated with obesity; the odds ratio (95% confidence interval), adjusted for age and cigarette smoking, was 1.3 (0.9, 1.8) in both black men and black women. Additional analyses showed that abdominal adiposity conferred increased risk. These findings suggest that both blacks and whites should avoid excess adiposity.
Usefulness of technetium-99m-MIBI and thallium-201 in tomographic imaging combined with high-dose dipyridamole and handgrip exercise for detecting coronary artery disease Forty-two patients with known stable coronary artery disease, referred for coronary angiography, were examined with technetium-99m-hexakis-2-methoxy-2-methylpropyl-isonitrile (MIBI) tomography combined with a high-dose dipyridamole infusion (0.7 mg/kg) and handgrip stress. MIBI tomography was unable to show coronary artery disease only in 2 patients, thus yielding a sensitivity figure of 95%. MIBI tomography correctly identified 27 (82%) of 33 stenotic lesions (greater than or equal to 50% diameter stenosis) of the left anterior descending artery, 17 (61%) of 28 of those of the left circumflex artery, and 28 (90%) of 31 of those of the right coronary artery. The overall vessel sensitivity was 78%. The computed lumen diameter stenoses were more advanced in cases detected than in those not detected with MIBI tomography: 87 +/- 14 vs 76 +/- 14% (p less than 0.01). The 50 to 69% stenoses did not show any tendency to produce less positive findings than those with greater than or equal to 70% stenoses. In the subgroup of 21 patients who also presented for thallium scintigraphy, the overall diseased vessel identification rate was 76% for thallium tomography and 83% for MIBI tomography (p = not significant). Minor noncardiac side effects related to the dipyridamole-handgrip test occurred only in 5% of 63 study sessions. A high-dose dipyridamole combined with isometric exercise is a safe stress method, and when used during scintigraphy, MIBI tomography is at least as efficient a tool as thallium tomography in detecting diseased vessel territories in patients in coronary artery disease.
Mechanism of production of scoliosis. A hypothesis. On the basis of previous studies on the vertebral column and thoracic skeleton, the author generated a hypothesis for the mechanism of production of scoliosis. According to this hypothesis, vertical stability of the thoracic spine is maintained by equal support through the ribs from both sides due to the equal load brought to the lamin by both the ribs through the costotransverse articulations and ligaments. Any interference in this balancing mechanism will disturb the mechanism of spinal stability, and the spine will bend toward the more heavier loaded side at the intervertebral joints. On the basis of this hypothesis, mechanisms of production of scoliosis (both in experimental animals and humans) after removal of ribs on one side can be explained. Removal of the ribs from one side produces an imbalance in the symmetric weight transmission through the ribs on the two sides. Pathologic deformations within the vertebrae in scoliosis results from the asymmetric load and the altered route of the load transmission on the convex side of the curve.