shukoor65/lab-rag-model huggingface dataset:
Short- and long-term psychological status following stroke. Short form MMPI results. Indices of self-reported depression and psychological adjustment after stroke were evaluated using a short form of the MMPI. Patients with poststroke periods of 2 to 6 and 7 to 24 months were selected, and indices of general intellectual functioning and lesion size/location were obtained. Despite similar levels of intellectual functioning and lesion parameters, the longer duration group showed significantly higher depression scores and significant (T greater than 70) elevations on several other clinical scales of the MMPI. In contrast, the mean overall profile of the short-duration group was roughly within normal limits. These findings have implications for the clinical assessment and treatment of stroke patients and long-term psychological adjustment after stroke.
Perioperative stroke. Part I: General surgery, carotid artery disease, and carotid endarterectomy. Although stroke, defined as a focal neurological deficit lasting more than 24 hr, is uncommon in the perioperative period, its associated mortality and long-term disability are high. No large-scale data are available to identify the importance of recognized risk factors for stroke in the perioperative period. A review of the literature shows that the incidence and mechanism of its occurrence are influenced by the presence of cardiovascular disease and the type of surgery. The most common cause of perioperative stroke is embolism. In non-cardiac surgery, the incidence of perioperative stroke is higher among the elderly. Properly administered, controlled hypotension is associated with minimal risk of stroke. Cerebral vasospasm may be the cause of focal cerebral ischaemia in eclamptic patients, and the aggressive treatment of hypertension may exacerbate the neurological damage. The risk of stroke associated with carotid endarterectomy is closely related to the preoperative neurological presentation, and the experience of the surgical/anaesthetic team. Symptomatic cerebrovascular disease, acute stroke, asymptomatic carotid lesions, preoperative assessment of risk, local and general anaesthesia, cerebral protection and monitoring during carotid endarterectomy are discussed with reference to reducing the risk of perioperative stroke. Adequate monitoring and protection have minimized the risk of ischaemia from carotid clamping, and the major mechanism of stroke is embolization.
Protein status and metabolic expenditure determine the response to intravenous nutrition--a new classification of surgical malnutrition. To determine whether nutritional and metabolic factors affect the response to intravenous nutrition (IVN) 146 surgical patients were classified according to their protein and metabolic status using direct measurements of body protein and metabolic expenditure. The patients were grouped into four categories: category I, moderate to severe protein depletion without raised metabolic expenditure; category II, moderate to severe protein depletion with raised metabolic expenditure; category III, mild protein depletion without raised metabolic expenditure; and category IV, mild protein depletion with raised metabolic expenditure. After 2 weeks of IVN patients in category I gained a mean(s.e.m.) of 0.43(0.06) kg of body protein (P less than 0.001) and had significant rises in both plasma transferrin and prealbumin (P less than 0.05); patients in category II gained 0.30(0.11) kg of protein (P less than 0.005) and also had significant rises in transferrin and prealbumin (P less than 0.05). Patients in category III lost 0.24(0.11) kg protein (P less than 0.05) and had no changes in either transferrin or prealbumin and patients in category IV lost 0.51(0.13) kg of body protein (P less than 0.001) and although there was a significant rise in plasma prealbumin there was no significant change in plasma transferrin. When postoperative patients were examined separately, they did not differ significantly from preoperative patients except in category I, where their protein gain was only 0.19(0.10) kg, an amount not significantly different from that gained by patients in category II. In each of the four categories described, the changes in total body protein occurring with 2 weeks of IVN were determined by the relative effects of two competing processes; protein depletion and raised metabolic expenditure. With moderate to severe protein depletion (approximately 30 per cent depletion of body protein stores) there was a marked tendency to gain protein with IVN. When the patient had a raised metabolic expenditure or was postoperative this tendency of depleted patients to gain protein was still present but it was less. With only mild protein depletion (approximately 10 per cent depletion) increases in metabolic expenditure made it difficult, if not impossible, to prevent continuing protein loss in spite of aggressive nutritional support. The patient categories we have described determine the response to IVN and form the basis of a new clinical classification of surgical malnutrition.
Inflammatory pseudotumor of the spleen. Morphological, radiological, immunophenotypic, and ultrastructural features. A case of inflammatory pseudotumor of the spleen is described. Its rapid enlargement, demonstrable by ultrasound studies and computed tomographic scan, its gross appearance, and some of its histologic features suggested malignant lymphoma. However, a characteristic circumferential zonal pattern and polytypic immunophenotype helped to establish the correct diagnosis. In retrospect, the zonal pattern was also identified radiologically.
Regulation of the oncodevelopmental expression of type 1 chain ABH and Lewis(b) blood group antigens in human colon by alpha-2-L-fucosylation. Blood group antigen expression in the distal human colon is related to the development of the organ and is modified by malignant transformation. To elucidate the biochemical basis for these changes, we have (a) analysed the activity of glycosyltransferases coded for by the H, Se, Le, X, and A genes, in tissue biopsy specimens from normal and malignant proximal and distal human colon; (b) characterised the glycosphingolipids expressed in the various regions of normal and malignant colon by immunostaining of high performance thin layer chromatography plates; and (c) located the antigens on tissue sections from the same subjects by immunohistochemistry. In both secretors and non-secretors we found a significantly higher activity of alpha-2-L-fucosyltransferases in carcinomatous rectal tissue than in tissue from normal subjects, whereas the other transferase activities studied showed no significant differences. The acceptor substrate specificity suggested that both the Se and the H gene dependent alpha-2-L-fucosyltransferases are increased in carcinomas. In non-malignant tissue the only enzyme which showed appreciably higher activity in caecum than in rectum was alpha-2-L-fucosyltransferase. Immunochemistry and immunohistochemistry showed alpha-2-L-fucosylated structures in normal caecum from secretors and in tumour tissue from both secretors and non-secretors. We conclude that the alpha-2-L-fucosyltransferases control the expression of ABH, and Lewis(b) structures in normal and malignant colon.
Follow-up study of unruptured aneurysms arising from the C3 and C4 segments of the internal carotid artery. A follow-up study of unruptured aneurysms arising from the C3 and C4 segments of the internal carotid artery was performed. During the 10-year period from 1979 to 1989, there were 22 patients with 24 aneurysms arising from the C3 or C4 segment of the internal carotid artery. All 24 aneurysms were unruptured. They represented 3% of all intracranial aneurysms and 11% of all internal carotid artery aneurysms diagnosed at the hospital during the 10-year period. Eighteen patients were women and 4 were men. Their ages ranged from 34 to 82 years (mean 63.3 years). Of the 22 patients, 12 (55%) had multiple aneurysms. A follow-up study without treatment was made in 15 of the 22 patients who had a total of 16 unruptured aneurysms arising from the C3 or C4 segment of the internal carotid artery. This study excluded 7 of the 22 patients with a total of eight aneurysms because of operation or death soon after diagnosis. The average maximal dimension of the 16 aneurysms was 5 mm, with a range of 2-17 mm. Follow-up periods varied from 11 months to 10.5 years, with an average of 4.7 years. During this period, none of the 16 aneurysms ruptured, and they remained asymptomatic, except for one aneurysm that had been discovered as a result of the cavernous sinus syndrome. Some surgeons are now attempting direct operations on intracavernous carotid artery aneurysms, even if the aneurysms are unruptured and relatively small.
Abdominal aortic aneurysms complicated by spontaneous iliocaval or duodenal fistulae. Seven hundred and twenty one abdominal aortic aneurysms were treated between 1960 and 1985. Twenty one of these (2.9%) were complicated by the development of a spontaneous primary fistula, 16 (2.2%) into the vena cava or iliac veins and 5 (0.7%) into the duodenum. A correct preoperative diagnosis was made in only four instances, two aorto-caval and two aorto-duodenal fistulae. Hospital mortality was 44% for aorto-caval and 60% for aorto-duodenal fistulae. Despite the lack of a precise preoperative diagnosis in the majority of cases, the prognosis for aorto-caval fistula remained comparable to that for patients undergoing emergency surgery for uncomplicated ruptured aortic aneurysms. The mortality of spontaneous aorto-duodenal fistulae was appreciably higher and the aneurysmal contents of 4 out of these 5 cases had positive bacterial cultures.
A case of intracerebral air embolism secondary to the insertion of a Hickman line. Complications following the insertion of intravenous catheters are relatively uncommon. We report a potentially serious, hitherto unrecognized complication of Hickman line insertion, and discuss the condition.
Isolation and direct characterization of resident microglial cells from the normal and inflamed central nervous system. In addition to the major population of infiltrating leukocytes recovered from inflamed rat central nervous system (CNS), all of which expressed high levels of leukocyte common antigen CD45, many cells were coisolated that were MRC OX42+ (complement receptor 3/CD11b) but expressed low-to-moderate levels of CD45 and major histocompatibility complex (MHC) class I molecules. Most cells from normal CNS, in contrast, lay within this latter, CD45low population. From previous in situ immunohistochemical studies, the fortuitously isolated CD45low cells were probably resident (ramified) microglia. Using irradiation chimeras, we show that resident microglia respond to inflammation by upregulating CD45, CD4, and MHC class I molecules with a minority of these cells increasing their expression of MHC class II molecules. A 3- to 4-fold increase in the number of microglia isolated from inflamed CNS provided indirect evidence that the cells had proliferated. In normal CNS, a very small population of blood-derived CD45high-expressing cells are present; most MHC class II expression is associated with these few cells and not with the resident microglia.
Grading of human urothelial carcinoma based on nuclear atypia and mitotic frequency. I. Histological description. The World Health Organization (WHO) grade II bladder tumors constitute a clinically and histologically heterogeneous group due to imprecise histological definitions. In an attempt to improve this problem 124 transitional cell carcinomas of the bladder were histologically reviewed using a modified Bergkvist system. The grade II tumors were divided into 2 groups, grades IIa and IIb, mainly with reference to the degree of nuclear atypia and number of mitoses. Using definitions possible to express by numerical means, the separation was easy and reproducible. Due to great histological resemblance between certain close grades we propose a new grading system with 3 grades combining I and IIa (grade A), IIb and III (grade B), and a third group (grade C) for the anaplastic tumors.
Typical and atypical bronchopulmonary carcinoids. A clinicopathologic and flow cytometric study. The clinicopathologic and flow cytometric characteristics of 47 bronchopulmonary carcinoids were assessed, relative to patient survival. Aneuploidy was associated more often with tumor size of greater than or equal to 3.0 cm (P less than 0.004) and lymph node (P less than 0.013) or vascular involvement (P less than 0.004). Also, an aneuploid DNA content was seen significantly more often in histologically atypical (79%) than in typical carcinoid neoplasms (18%) (P less than 0.0001). Cox proportional hazard model analysis revealed that the histologic category (typical vs. atypical) and ploidy pattern were important prognostic indicators. Size of the primary tumor and the presence of vascular involvement were also significant predictors of outcome. Histologically atypical carcinoids with diploid DNA content pursued a less aggressive course than did their aneuploid counterparts.
Down's syndrome and mixed acute leukemia in infants. The routine use of panels of monoclonal antibodies has been complementary to the French-American-British (FAB) leukemia classification, and has unmasked the occurrence of mixed acute leukemia (myeloid-lymphoid). It is widely accepted that children with Down's syndrome (DS) have a high incidence of acute leukemia. There is an extensive body of literature emphasizing the cytogenetic findings in these children. However, information as to the immunophenotype is often limited to the lymphoid surface determinants. The authors report two children with DS whose leukemic blasts were studied with a panel of 17 monoclonal antibodies (myeloid, lymphoid, and megakaryocytic) by flow cytometric examination and were classified as biphenotypic acute leukemia. The blast population coexpressed myeloid and T-cell surface markers. The lymphoid origin was ruled out on the basis of negative terminal deoxynucleotidyl transferase and molecular analysis demonstrating germline configuration for the JH and beta TCR genes.
The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: a review. In recent years, doubt has been shed on the necessity of mastectomy for women with early-stage breast cancer. Apart from purely medical studies comparing (radical) mastectomy to less intruding surgical treatment, a number of studies (N = 18) have been published investigating the impact of breast-conserving treatment versus mastectomy on quality of life. We review these studies with respect to medical issues (treatment modality, stage of disease), methodologic issues (design, measurement moment, sample size), and results (psychologic discomfort, changes in life patterns, fears and concerns). It is concluded that there is no solid proof of a better psychologic adjustment after breast-conserving treatment and that there are no substantial differences between the different treatment modalities in changes of life patterns and fears and concerns. However, the results with respect to body image and sexual functioning favor the use of breast-conserving treatment.
Termination of central sleep apnea episodes by upper airway stimulation using intermittent positive pressure ventilation. A 52-year-old man presented with pure central sleep apnea syndrome that failed to respond to nasal continuous positive airway pressure (NCPAP) therapy. Intermittent positive pressure stimulation via a nasal mask was instituted using a portable positive pressure ventilator. We found marked reduction in the respiratory disturbance index, number of desaturations, and the number of arousals with this mode of therapy.
Prevalence of obesity in a Native Hawaiian population. Mortality data indicate that Native Hawaiians have higher death rates when compared with the US all-races population, and full-blooded Native Hawaiians are likely to have the highest mortality rates from heart disease in the nation. However, to date no comprehensive population-based study of risk factors in Native Hawaiians has been conducted. In this study of 257 Native Hawaiian adults, 62.8% of the women and 65.5% of the men were greater than or equal to 20% overweight by the second National Health and Nutrition Examination Survey (NHANES II) standards. Thirty-four percent of the women and 47% of the men were severely overweight. The mean body mass index (BMI, in kg/m2) was 30.3 in women and 30.9 in men. Women aged 45-54 y were heaviest with a mean BMI of 31.6. Of the men aged 25-34 y, 79.2% were overweight. The mean waist-to-hip ratio was 0.85 for women and 0.95 for men in this sample.
Mitomycin C-loaded microcapsules in the treatment of colorectal liver metastases. Pharmacokinetics of regionally administered particulate chemotherapy. Microencapsulated mitomycin C has been used for the treatment of intrahepatic tumors in Japan, but there have been no reports of its use in western countries. In this study, the pharmacokinetic profile of intrahepatic arterial mitomycin C microcapsules is reported. Regional mitomycin C was administered to six patients, both in the microencapsulated form and in solution. The clearance (140 +/- 31 1/hour, mean +/- SD) and half-life of drug in plasma (0.39 +/- 0.03 hours), and volume distribution (246 +/- 23 1) were significantly higher, and peak drug concentrations (80 +/- 75 ng/ml) significantly lower with the microencapsulated preparation than with the free drug (clearance, 46 +/- 8 1/hour; half-life, 0.11 +/- 0.02 hours; volume distribution, 33 +/- 4; peak drug concentration, 812 +/- 423 ng/ml), on Student's t testing (P less than 0.05). The results show that very little systemic exposure is associated with the microencapsulated form of mitomycin C. Dose escalation should be feasible without increasing systemic toxicity.
Expression of glutathione S-transferase-pi messenger RNA in human esophageal cancers. The expression of human glutathione S-transferase-pi (GST-pi) in resected primary esophageal tumors and in matching normal esophageal mucosa from 25 patients undergoing radical surgery was measured by RNA blot hybridization. The RNA transcript levels of GST-pi in the tumor tissues were higher than those in normal tissues in 20 of 25 cases (80%). The mean GST-pi mRNA value in the tumor tissues (n = 25) was significantly (P less than 0.01) elevated as compared with that in background mucosa (n = 29), and in ten of 25 tumors (40%) the level of GST-pi mRNA exceeded the mean normal tissue value by two standard deviations (normal mean value + 2 X SD). The results obtained from the current experiment thus suggests that GST-pi might be a useful marker for human esophageal cancer. No correlation between GST-pi mRNA level and clinical stage or histologic characteristics was apparent.
Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy. OBJECTIVE: Women with ectopic pregnancy (EP) who have been operated on by laparoscopy are thought to have improved subsequent fertility, probably because of less adhesion formation. We aimed to evaluate the adhesion formation after laparoscopy as compared with laparotomy in a randomized trial. DESIGN: One hundred five patients with tubal pregnancy were stratified with regard to age and risk factors and randomized to surgery by laparoscopy or laparotomy. To evaluate adhesion formation and tubal status, 73 patients with strong desire of pregnancy underwent a second-look laparoscopy. The adhesion status at the ipsilateral and contralateral side at primary surgery was compared with the status at second-look laparoscopy. RESULTS: Patients operated on by laparotomy developed significantly more adhesions at the operated side than patients operated on by laparoscopy (P less than 0.001). Substantially more patients in the laparotomy group underwent adhesiolysis at second-look laparoscopy than did patients in the laparoscopy group. Tubal patency did not differ between the groups. CONCLUSIONS: Laparoscopic treatment of EP results in less impairment of the pelvic status compared with conventional conservative surgery.
Expression of intrahepatic hepatitis D viral antigen in chronic hepatitis D virus infection. To elucidate the biological importance of intrahepatic hepatitis D virus antigen, its expression was correlated with biochemical and histological inflammatory activity in 98 biopsy specimens from 68 patients seropositive for total antibody to the virus. Seventy five specimens were positive for intrahepatic nuclear antigen for HDV antigen accompanied by cytoplasmic HDV antigen in only one biopsy specimen. This group had significantly higher serum transaminase activities and inflammatory activity than the remaining cases that were negative for HDV antigen. Among the group positive for HDV antigen, there was no correlation between the proportion of hepatocytes containing HDV antigen and either serum transaminase activity or histological inflammatory indices. In 22 HDV antigen positive patients who had follow up biopsy specimens taken at a median of two years, the proportion with cirrhosis increased from 36% to 73%. Serum transaminase activities remained the same during this period, but the proportion of HDV antigen positive cells dropped. Follow up of 51 patients showed that 21 died or underwent liver transplantation within three years. The absence of an association between intrahepatic HDV antigen expression and progression of histological liver damage does not support the view that HDV is directly cytopathic to hepatocytes. Immune mediated mechanisms may have a role in the pathogenesis of chronic liver disease related to HDV infection.
Patterns of mortality in sickle cell disease in the United Kingdom. Eighteen of 384 patients entered on the Brent sickle cell disease register died between 1974 and 1989, a mortality of one per 128 years of follow up. Two children died from acute splenic sequestration and a third died from fulminant pneumococcal septicaemia: none was taking prophylactic penicillin. Acute chest syndrome was the cause of death in eight young adults and one child. Three deaths occurred after surgery. Cerebrovascular accidents contributed to the cause of death in three cases and there were two sudden unexplained deaths. Ten of the deaths occurred at home or within 24 hours of admission to hospital. Post mortem examinations were made in 14 cases, but the histological appearances of acute chest syndrome were often not recognised. In most cases for whom information was available, the cause of death (chest syndrome, pneumococcal sepsis, postoperative complications) could have been prevented.
Evidence of c-myc gene abnormalities in mediastinal large B-cell lymphoma of young adult age. Six cases of mediastinal large B-cell lymphoma (MLCL) with sclerosis were analyzed for the presence and patterns of c-myc and bcl-2 loci rearrangements, and for the presence of Epstein-Barr virus DNA sequences by Southern blot hybridization, c-myc gene alterations were found in three of six cases. Two cases showed the presence of mutations or small rearrangements at the 3' end of the first exon. The c-myc gene abnormalities found in these two cases are similar to those observed in the translocation 8;14 of the endemic Burkitt's lymphomas or in its variants t(2;8) and t(8;22). A third case showed a major rearrangement of c-myc gene, with truncation within its first intron, similar to those observed in sporadic Burkitt's and in acquired immunodeficiency-associated lymphomas. None of the cases displayed bcl-2 gene rearrangements or contained viral sequences. Our data suggest a possible role for a translocation-mediated c-myc activation in the pathogenesis of MLCL. Conversely, bcl-2 gene and Epstein-Barr virus do not appear to be involved in the pathogenesis of these peculiar lymphomas. The association between c-myc structural modifications and MLCL also seems to be of relevance in light of the peculiar tendency of this tumor to involve unusual extranodal site (eg, kidney), reminiscent of the spreading attitude of Burkitt's limphomas.