shukoor65/lab-rag-model huggingface dataset:
Problems encountered in leg shortening. We reviewed 46 leg-shortening operations (37 femoral and nine tibial), performed by different methods, to assess the incidence of complications and permanent disability. Shortening of as much as 7.5 cm in the femur and 5 cm in the tibia was achieved in men of normal height without any loss of function. Complications were seen with all surgical techniques despite the use of modern implants. Most problems arose from inadequate stabilisation of the osteotomy. The most reliable method of femoral shortening was open subtrochanteric osteotomy with preservation of the isthmus, and fixation with an intramedullary nail locked at its proximal end. In tibial shortening, bone excision should be at the level of the flare in the lower diaphysis in order to achieve reliable bone healing. Simple intramedullary nail fixation should be supplemented with a long-leg cast for six weeks or the nail should be locked at both ends to prevent postoperative distraction or rotation.
Estrogen and progesterone receptors in lymphangioleiomyomatosis, epithelioid hemangioendothelioma, and sclerosing hemangioma of the lung. The therapeutic options in the treatment of lung neoplasia usually have not included hormonal therapy, unlike those for primary tumors of other sites (e.g., breast). However, two mesenchymal proliferations of lung, lymphangioleiomyomatosis and epithelioid hemangioendothelioma (EHE), and one epithelial tumor, sclerosing hemangioma (SH), have a significant female predilection and may benefit from such hormonal therapy. The authors investigated five cases each of EHE and lymphangioleiomyomatosis and four cases of SH for expression of estrogen and progesterone receptors and 17-beta estradiol in paraffin-embedded tissue. Only one case each of lymphangioleiomyomatosis and EHE expressed 17-beta estradiol. All of the other cases were negative. These findings are contrary to the viewpoint held in published literature, especially in case reports of lymphangioleiomyomatosis, describing patients with positive estrogen and progesterone receptor results. Consequently, a number of issues must be considered in the clinical and immunohistochemical evaluation of the estrogen and progesterone receptor status of these rare pulmonary neoplasms.
Stapes surgery: complications and airway infection. From a group of 1,111 patients who had stapedectomy or stapedotomy performed in a 10-year period, a thorough investigation was made of 11 patients who had a total hearing loss and 8 patients who developed a partial sensorineural hearing loss after operation. The data obtained indicate that postoperative infection with influenza virus may be responsible for unexpected complications following stapedectomy. A close relation was found between the appearance of complications and periods of epidemics of influenza.
Surgical management of perilymph fistulas. A new technique. A wide range of recurrence rates (21% to 47%) for perilymph fistula repairs have been reported in the otology literature. An improved surgical technique developed at the Portland (Ore) Good Samaritan Hospital and Medical Center Neurotology Department was used to repair perilymph fistulas in 58 patients from October 1986 to October 1988. Our recurrence rate was reduced from 27% in a 1982-1985 study to 8% in our study. At 1 year postoperatively, improvements in disequillibrium, dizziness, and vertigo were comparable with results of older surgical techniques. Functional outcomes were also good: 83% of patients returned to normal activities of daily living, and 71% also returned to school or resumed gainful employment outside the home.
Unsuspected sphincter damage following childbirth revealed by anal endosonography. Anal endosonography was performed in 62 consecutive patients with incontinence of flatus or faeces following obstetric trauma, and in 18 parous controls. Of the incontinent group, 90% had defects in the external sphincter, 65% in the internal sphincter and 44% disruption of the perineal body, compared with none of the controls. This triad of lesions is pathognomonic of obstetric trauma. Anal endosonography revealed a higher prevalence of sphincter damage than expected from anorectal physiology tests, and therefore has a role in screening patients following complicated or difficult deliveries.
Tuberculosis diagnosed at death in the United States. From 1985 through 1988, 5.1 percent of TB cases reported in the United States were diagnosed at death. Differences in the proportions diagnosed at death by race/ethnicity, sex, and place of birth (United States vs foreign-born) were relatively small. The proportion of cases diagnosed at death increased with age, from 0.7 percent in patients less than 5 years old to 18.6 percent among patients 85 years and older. Only 26.0 percent of cases diagnosed alive were among those 65 years and older, but 60.3 percent of those diagnosed at death were in this age group. Eighteen percent of cases with miliary, meningeal and peritoneal TB were diagnosed at death, compared with 4.8 percent among those with pulmonary TB. These data indicate that TB too often remains unrecognized and that, to prevent continuing deaths from this curable disease, a high index of suspicion of TB remains important, particularly among the elderly and among persons with extrapulmonary sites of disease.
Potential for mosquito transmission of attenuated strains of Rift Valley fever virus. Studies were conducted to determine if two attenuated strains of Rift Valley fever (RVF) virus could be transmitted by Culex pipiens mosquitoes. Both strains (RVF MP 12 and T1) replicated in and were transmitted by female Cx. pipiens after intrathoracic inoculation. Mosquitoes also became infected with and transmitted the RVF MP12 strain after ingesting virus from a blood-soaked cotton pledget. However, because of the low viremias produced in infected animals, it is unlikely that mosquitoes would become infected by feeding on an animal inoculated with either of these viruses. Although both strains were transmitted by mosquitoes after intrathoracic inoculation, there was no evidence of reversion to a virulent virus.
Fungal sinusitis in immunocompromised children with neoplasms. This paper reviews the treatment and diagnosis of immunocompromised patients with fungal sinusitis at St Jude Children's Research Hospital. Sinusitis of all types was found to be more common in patients with hematopoietic neoplasms than in patients with solid tumors; 42% of patients with leukemia had abnormal sinus radiographs. Eight cases of pathologically proven fungal sinusitis were identified. All patients were undergoing chemotherapy for either acute myeloblastic leukemia or acute lymphoblastic leukemia and had neutrophil counts less than 100 cells/mm3. The most common findings were fever, facial pain, and abnormal sinus radiographs. Surveillance cultures of the upper aerodigestive system did not reliably predict sinus pathogens. An aggressive treatment approach consisting of early administration of amphotericin B (intravenously and via catheter irrigations of the sinuses) and surgical drainage is advocated. There was an 80% survival rate in patients in remission who were undergoing maintenance chemotherapy. All patients undergoing chemotherapy for relapse died.
Thoracic outlet syndrome caused by tumor of the first rib. We report a new case of thoracic outlet syndrome caused by a tumor of the first rib and review 11 other reports found in the literature. A 25-year-old man was admitted with thoracic outlet syndrome in the C8-T1 nerve roots. The first rib was removed through a supraclavicular approach with excision of the medial clavicle. All symptoms disappeared. On histologic examination fibrous dysplasia was found in the rib. Tumors of the first rib are uncommon and are rarely responsible for thoracic outlet syndrome. When the tumor is very large, as in our case, we recommend a supraclavicular approach associated with excision of the medial clavicle. During the liberation of the brachial plexus, great care should be exercised to avoid nerve injuries. Because malignancy of the tumor cannot be eliminated with certainty before or during the operation, wide excision of the entire rib is recommended.
Treatment of systemic vasculitis with pooled intravenous immunoglobulin. The therapeutic effect of a course of high-dose, pooled, intravenous immunoglobulin (IVIg) on disease activity and circulating antineutrophil cytoplasm antibodies (ANCA) was investigated in 7 patients with systemic vasculitis. 5 had active disease despite conventional immunosuppression, and 2 had not received any treatment. All 7 had clinical improvement, which was sustained in 6 and transient in 1. The fall in ANCA concentrations to a mean of 51% of the pre-treatment values was maintained during follow-up. C-reactive protein concentration also dropped considerably. IVIg seemed to confer a useful therapeutic effect without adverse reaction.
Malignant melanoma in transgenic mice. Ocular and cutaneous melanomas arose in new inbred lines of transgenic mice having an integrated recombinant gene comprised of the tyrosinase promoter, expressed in pigment cells, and the simian virus 40 early-region transforming sequences. The tumors were hypomelanotic and were histopathologically similar to corresponding human melanomas. Eye melanomas often originated at a young age, chiefly from the retinal pigment epithelium, also from the choroid, and rarely from the ciliary body. The eye tumors grew aggressively, were highly invasive, and metastasized to local and distant sites. The earliest formation of these tumors was associated with higher copy numbers of the transgene; mice of different single-copy lines varied greatly in age of onset and frequency of eye tumors. Coat pigmentation was reduced in almost all lines, to various extents. Primary skin melanomas arose later and less frequently than eye melanomas. Hence they were at early stages and of unknown long-range incidence in this investigation, in which autopsies covered the first half-year of life. For both ocular and cutaneous melanomas, the transgenic mice offer numerous possibilities for experimental study of mechanisms underlying formation and spread of melanomas.
Crohn's disease associated with autoimmune neutropenia. We report a 29-year-old woman with a 20-year history of Crohn's disease and neutropenia. Because of repeated complications of Crohn's disease, she has undergone three intestinal resections and also has had recurrent skin abscesses, sinusitis, and pneumonia. Persistent neutropenia has been noted throughout the course of her disease, and antineutrophil antibodies have been detected in her serum and that of her younger brother, who also has Crohn's disease and neutropenia. We discuss autoimmune neutropenia in the context of other autoimmune manifestations of Crohn's disease and speculate as to its possible contributory role in the pathogenesis of Crohn's disease.
Preferential DNA secondary structure mutagenesis in the lagging strand of replication in E. coli. When present in single-stranded DNA, palindromic or quasi-palindromic sequences have the potential to form complex secondary structures, including hairpins, which may facilitate interstrand misalignment of direct repeats and be responsible for diverse types of replication-based mutations, including deletions, additions, frameshifts and duplications. In regions of palindromic symmetry, specific deletion events may involve the formation of a hairpin or other DNA secondary structures which can stabilize the misalignment of direct repeats. One model suggests that these deletions occur during DNA replication by slippage of the template strand and misalignment with the progeny strand. The concurrent DNA replication model, involving an asymmetric dimeric DNA polymerase III complex which replicates the leading and lagging strands, has significant implications for mutagenesis. The intermittent looping of the lagging strand template, and the fact that the lagging strand template may contain a region of single-stranded DNA the length of an Okazaki fragment, provides an opportunity for DNA secondary-structure formation and misalignment. Here we report our design of a palindromic fragment to create an 'asymmetric palindromic insert' in the chloramphenicol acetyltransferase gene of plasmid pBR325. The frequency with which the insert was deleted in Escherichia coli depends on the orientation of the gene in the plasmid. Our results suggest that replication-dependent deletion between direct repeats may occur preferentially in the lagging strand.
Endocrine response determines the clinical outcome of pulsatile gonadotropin-releasing hormone ovulation induction in different ovulatory disorders. To accrue systematic information in different ovulatory disorders on the precise relationship among endocrine response, clinical outcome, and the occurrence of complications, we treated 114 patients with pulsatile GnRH (2.5-5.0 micrograms, iv, every 60 min) for 187 cycles and compared them to 20 normal menstrual cycles. Thirty of these patients had primary hypogonadotropic amenorrhea (PHA; 40 cycles), 33 had other forms of hypogonadotropic hypogonadism (HH; 55 cycles), and 51 had polycystic ovary syndrome (PCOS; 92 cycles). Daily blood samples were drawn for hormone determinations. In PCOS, 50 cycles were preceded by GnRH analog suppression. PHA treatment cycles were characterized by the reestablishment of a normal endocrine pattern, almost no dose-related endocrine differences, elevated ovulatory (93%) and conception rates (23%), and no multiple pregnancies. In the HH subjects the ovulatory (91%) and pregnancy rates (31%) were high; however, while the lower GnRH dose elicited a normal endocrine pattern, the 5-micrograms dose induced excessive folliculogenesis and high estradiol levels and was associated with most of the multiple pregnancies of this study (three of four). GnRH analog suppression was successfully used to avoid recurrence of ovarian over-stimulation in two HH subjects. Finally, GnRH analog suppression in PCOS permitted normalization of the follicular phase endocrine pattern, achievement of good ovulatory (76%) and pregnancy (28%) rates, and avoidance of multiple pregnancies; however, luteal phase steroid secretion was abnormal, and the abortion rate remained elevated (43%). Obesity was associated with a reduced ovulatory rate in PCOS, but not in hypogonadotropic, subjects. Thus, we can conclude that in pulsatile GnRH ovulation induction: 1) a profound hypogonadotropic condition, whether spontaneous as in PHA or induced with GnRH analogs as in other ovulatory disorders, is associated with optimal menstrual cycle restoration, high ovulatory and conception rates, and virtually absent risks of multiple pregnancy; 2) residual hypothalamic activity in HH may be responsible for supraphysiological pituitary-ovarian stimulation and result in multiple pregnancy unless a low GnRH dose (2.5 micrograms/bolus) or GnRH analog pretreatment is employed; 3) obesity does not affect treatment outcome in hypogonadotropic patients; and 4) the high spontaneous abortion rate in PCOS may be related to corpus luteum dysfunction.
Symptomatic talocalcaneal coalition. Its clinical significance and treatment. The clinical significance of symptomatic talocalcaneal coalition was described subjectively, objectively, and identified roentgenographically after examining 67 feet of 42 patients between 1977 and 1987. Computed tomographic examinations, conducted on 29 of 42 patients, were useful in recognizing the extent of coalition, the condition of union, and the postoperative results. Tarsal tunnel syndrome was present in 23 feet with the coalition. Thirty-one feet (24 patients) were treated conservatively and 36 feet (29 patients) surgically. Of the surgically treated feet, the coalition was excised in 33 and talocalcaneal fusion was performed in three. Follow-up examinations were performed at an average of 5.3 years (range, 2.25-11.2 years). In the excision group, the results were excellent in 24 feet, good in seven, and fair in two. The results were good in three feet treated by arthrodesis.
Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. The present study evaluated the incidence of gallstone formation in 105 morbidly obese patients undergoing rapid weight loss after proximal gastric bypass surgery. Intraoperative ultrasonography demonstrated gallstones in 20 (19%) and gallbladder sludge in four (4%) patients. Eighty-one patients had a normal gallbladder ultrasound. After bariatric surgery, these patients were followed prospectively with periodic gallbladder ultrasound examinations. At 6 months, gallstones had developed in 36% and gallbladder sludge in 13% of patients. These percentages remained relatively constant at 12 and 18 months. Body weight declined rapidly after surgery from a mean of 132.3 kg to 95.5, 87.0, and 84.0 kg at 6, 12, and 18 months, respectively. Gallstones developed significantly more often in the white race, and in women. No significant differences in age, body weight, percent ideal body weight, percent weight loss, or percent of excess body weight lost existed between patients who developed gallstones or sludge and those who did not. Patients who developed gallbladder sludge had less cholesterol and lower cholesterol saturation (1.25 +/- 0.42) in their gallbladder bile than persons who developed gallstones (2.00 +/- 0.79). Forty percent (13/32) of patients who developed gallstones became symptomatic; nine (28%) underwent elective cholecystectomy. An attempt to prevent gallstone formation during rapid weight loss appears warranted.
HIV-1 propagates in human neuroblastoma cells. A major question in the pathogenesis of AIDS encephalopathy and dementia is whether HIV-1 directly infects cells of the central nervous system (CNS). The propagation of HIV was attempted in six cell lines: three related and three unrelated to the nervous system. HIV was able to propagate in two human neuroblastoma cell lines and a lymphocytic cell line control but did not result in infections of African green monkey kidney cells, human cervix carcinoma cells, and one human brain astrocytoma cell line. Neuroblastoma cell lines infected with HIV showed peaks of reverse transcriptase activity at 10-14 days postinfection. After prolonged growth in cell cultures, one of the neuroblastoma cell lines showed multiphasic virus production, additional high peaks of reverse transcriptase activity, 20-fold greater than the first, lasting from 36 to 74 days and 110 to 140 days postinfection. The presence of HIV was confirmed by p24 antigen capture. The neuroblastoma cell lines had weak but detectable levels of CD4 immunoreactivity by immunoperoxidase and flow immunocytometric analysis. Although no T4-specific RNA sequences were detected by hybridization of Northern blots of total and poly A-selected RNA extracted from the two neuroblastoma cell lines by using a T4 specific complimentary DNA probe, monoclonal antibodies to the CD4 receptor blocked HIV infection in both neuroblastoma cell lines. Thus, the infection of neuroblastoma cells by HIV occurs in part by a CD4-dependent mechanism. Passaging the neuroblastoma cell lines weekly and bimonthly resulted in similar cell cycle-DNA content patterns for the more permissive cell line and with significant numbers of cells in the S phase. HIV-infected neuroblastoma cell lines provide an in vitro model for the evaluation of virus-host cell interactions and may be useful in addressing the issue of the persistence of HIV in the human CNS.
Value of computed tomography of the lung in the management of primary spontaneous pneumothorax. The treatment of patients with primary spontaneous pneumothorax remains controversial, since recurrence and the ultimate need for thoracostomy cannot be predicted. In the current study, computed tomography (CT) of the lung was performed prospectively on 26 consecutive patients with primary spontaneous pneumothorax to determine whether the size and/or the number of apical blebs would correlate with recurrence and/or need for thoracostomy. Both the number of blebs and the bleb score (calculated by the number of blebs multiplied by a numeric value assigned a range of bleb sizes) of the affected lung was significantly greater in patients with a history of recurrent pneumothorax and/or ultimate need for thoracostomy as treatment. CT of the lung may be useful in predicting the natural history of pneumothorax.
Preclinical Parkinson's disease: detection of motor and nonmotor manifestations. The advent of possible protective therapies for Parkinson's disease has created a need for methods of diagnosing the disease before the clinical features become fully evident. As a number of motor and nonmotor manifestations of the disease emerge months to years before a diagnosis can be made, a battery of clinical tests might be sufficient to identify individuals at an earlier stage than is currently possible using the standard history and physical examination. A list of questions regarding possible risk factors, specific symptoms, and observations of family members could be combined in a self-administered questionnaire that might identify individuals with a high probability of early, but otherwise undiagnosable, Parkinson's disease. Identification of subtle motor features is another possible screening method. For example, handwriting and speech are commonly affected prior to diagnosis; thus, automated analysis of these motor actions might also provide detection of incipient disease.
Heart rate variability in patients with ventricular arrhythmias: effect of antiarrhythmic drugs. Antiarrhythmic Drug Evaluation Group (ADEG). The purpose of this study was to investigate whether heart rate variability could be reliably assessed in patients with ventricular arrhythmias and to evaluate whether it is affected by antiarrhythmic drugs. The study was based on an analysis of 239 ambulatory electrocardiographic (ECG) recordings obtained from 67 patients with frequent and complex ventricular arrhythmias enrolled in the Antiarrhythmic Drug Evaluation Group (ADEG) study. In each recording, after exclusion of premature ventricular complexes, the number of times during a 24 h period in which two consecutive sinus RR intervals differed by more than 50 ms was calculated. The total 24 h count from each recording was then used as an index of heart rate variability. This method is a reliable marker of cardiac parasympathetic activity. Recordings were analyzed at baseline (n = 56), during long-term treatment with amiodarone (n = 17), flecainide (n = 22) or propafenone (n = 17) and after washout in selected patients (n = 5). Despite the presence of a different number of arrhythmias, total 24 h counts in the same patient appeared reproducible over time (r = 0.83 between two different recordings, n = 49, p less than 0.0001). Baseline counts (median 1,698, range 26 to 13,648) were not correlated (r = 0.15) with the number of arrhythmias. The three antiarrhythmic drugs had a disparate effect on total 24 h counts: no change was observed in patients treated with amiodarone (median percent change [delta %]-8, p = NS), whereas a significant (p less than 0.025) decrease occurred in patients treated with flecainide (median delta % -56%) or propafenone (median delta % -64%).
Blood transfusion and survival after laryngectomy for laryngeal carcinoma. Survival of patients with surgically treated malignancy may be adversely affected by blood transfusion. Immune suppression due to transfusion has been implicated but remains unproven. We conducted a study of 240 patients with squamous cell carcinoma of the larynx undergoing laryngectomy to assess the effect of per-operative blood transfusion on survival.
Inclusion body myositis with cricopharyngeus muscle involvement and severe dysphagia. A patient with inclusion body myositis (IBM) is presented. Unusual aspects of this case include a myopathy of 36 years duration, severe dysphagia due to cricopharyngeus muscle dysfunction, improvement with cricopharyngeus myotomy, and a diagnostic cricopharyngeus muscle biopsy.