shukoor65/lab-rag-model huggingface dataset:
Acute lung injury induced by phospholipase A2. Structural and functional changes. On the basis of the observation that serum levels of phospholipase A2 (PLA2) are elevated in pancreatitis and systemic sepsis, and the association of these conditions with the subsequent development of acute lung injury, the present investigation examined the structural and physiologic consequences of intratracheal administration of PLA2 to adult male rats. Rats received direct intratracheal instillation of either control vehicle or 40,000 units/kg of PLA2 repurified from Naja naja venom. Animals treated with PLA2 showed higher cumulative mortality (33% versus 0%, n = 79; p less than 0.01) than did their control littermates. The PLA2-treated animals showed histologic evidence of acute lung injury characterized by interstitial and alveolar edema, accumulation of inflammatory cells, and alveolar wall thickening, which reached maximal severity 48 h after enzyme instillation. Forty-eight hours after PLA2 administration experimental animals had lower arterial oxygen tensions (73.9 +/- 7.66 mm Hg versus 96.7 +/- 2.52 mm Hg, mean +/- SEM; p less than 0.01), higher alveolar-arterial oxygen gradients (35.3 +/- 6.3 mm Hg versus 18.8 +/- 1.42 mm Hg, p less than 0.01), and higher wet-dry lung weight ratios (5.08 +/- 0.26, mean +/- SEM, n = 7 versus 3.29 +/- 0.08, n = 3; p less than 0.002) than did control animals. Lung lavage from experimental animals 48 h after PLA2 instillation showed increased total cell counts [(26.6 +/- 5.04) x 10(6) cells versus (4.69 +/- 1.48) x 10(6) cells; p less than 0.01], an increased percentage of neutrophils (34.2 +/- 4.6% versus 1.25 +/- 0.25%, mean +/- SEM; p less than 0.01), and increased protein concentrations in lavage fluid (0.38 +/- 0.06 mg/ml, mean +/- SEM, n = 4 versus 0.27 +/- 0.02 mg/ml, n = 5; p less than 0.05). The histologic and physiologic abnormalities had largely resolved by 240 h. These results suggest that PLA2 may be a potent mediator of lung inflammation and that intratracheal administration of PLA2 to adult rats may provide a useful experimental model of acute lung injury.
Word deafness and auditory cortical function. A case history and hypothesis. A patient who already had Wernicke's aphasia due to a left temporal lobe lesion suffered a severe deterioration specifically of auditory language comprehension, subsequent to right temporal lobe infarction. A detailed comparison of his new condition with his language status before the second stroke revealed that the newly acquired deficit was limited to tasks related to auditory input. Further investigations demonstrated a speech perceptual disorder, which we analysed as due to deficits both at the level of general auditory processes and at the level of phonetic analysis. We discuss some arguments related to hemisphere specialization of phonetic processing and to the disconnection explanation of word deafness that support the hypothesis of word deafness being generally caused by mixed deficits.
Prevalence and incidence of Becker muscular dystrophy. We measured the prevalence and incidence of Becker muscular dystrophy in the Northern Health Region of England, UK. Patients were identified from the records of the Regional Neurological Centre and Muscular Dystrophy Group laboratories, Newcastle upon Tyne, and by writing to local doctors. We used cDNA probes and/or dystrophin immunolabelling of muscle-biopsy samples to prove the diagnosis of all cases. Results were compared with the known prevalence and incidence of Duchenne muscular dystrophy. 73 patients alive and resident in the Northern Health Region were identified, giving a prevalence rate of 2.38/100,000. This compares with a prevalence of Duchenne muscular dystrophy of 2.48/100,000. The cumulative birth incidence of Becker muscular dystrophy (at least 1 in 18 450 male live births) was about one third that of Duchenne muscular dystrophy (1 in 5618 male live births), suggesting that the disorder is more common than previously thought.
Open lung biopsy does not correlate with pulmonary function after the adult respiratory distress syndrome. Abnormalities of pulmonary function occur following the adult respiratory distress syndrome (ARDS). To determine if open lung biopsy (OLB) during ARDS predicts late pulmonary function abnormalities, we examined nine survivors of ARDS who had OLB during ARDS. Open lung biopsy was performed within two weeks of the diagnosis of ARDS, and the following were scored by a pulmonary pathologist as to extent and severity: hyaline membranes (HM), interstitial fibrosis (IF), air space organization (AO), interstitial cellularity (IC), and type 2 cell proliferation (T2C). Pulmonary function tests performed at least one year after ARDS were also used for analysis. Percent predicted Dco, TLC, DL/VA, and FVC were regressed against extent, severity, and combined scores. No significant correlation was found despite impressive histologic abnormalities. These data suggest that the severity and extent of HM, IF, AO, T2C, or IC do not correlate with lung function following ARDS.
Effects of different angiotensin-converting enzyme (ACE) inhibitors on ischemic isolated rat hearts: relationship between cardiac ACE inhibition and cardioprotection. We determined the relationship between cardiac angiotensin-converting enzyme (ACE) inhibition and anti-ischemic efficacy of several structurally different ACE inhibitors or their prodrug esters perfused through the isolated rat heart. Seven ACE inhibitors inhibited cardiac ACE to varying degrees due to differences in uptake during perfusion through nonischemic rat hearts. Zofenopril-sulfhydryl and fosinoprilic acid were the most effective of the free inhibitors. Among the prodrugs, zofenopril and S-benzoylcaptopril, hydrolyzed rapidly by cardiac esterase, were more effective than their component ACE-inhibitors, whereas fosinopril, ramipril and enalapril were poorly active. For studies in ischemic rat hearts, vehicle or drug treatment was initiated 10 min before a 25-min period of global ischemia and during a 30-min reperfusion period. Of five unesterified ACE inhibitors studied for anti-ischemic activity, only captopril and zofenopril-sulfhydryl were found to improve postischemic contractile function and reduce cell death in the isolated rat hearts. Fosinoprilic acid, ramiprilat and enalaprilat were not cardioprotective at high perfusion concentrations, despite the fact that nearly complete inhibition of cardiac ACE was achieved with all of the compounds studied. The S-benzoyl prodrugs of zofenopril-sulfhydryl and captopril were at least as potent as their component ACE inhibitors in reducing ischemic-reperfusion damage in the same model. Neither zofenopril nor captopril, however, had any effect on coronary flow before or after ischemia. Thus, it appears that the cardioprotective effects of zofenopril and captopril are independent of cardiac ACE inhibition or, at least, that ACE inhibition alone is not sufficient. Both captopril and zofenopril are sulfhydryl-containing compounds whereas the inactive compounds are not; and, thus, this group appears to be important in mediating their cardioprotective actions.
Endosonographic TNM staging of extrahepatic bile duct cancer: comparison with pathological staging. Endosonography was performed preoperatively in 33 patients with common bile duct carcinoma and in 43 patients with carcinoma of the common hepatic duct and its bifurcation. The results were correlated with the histology of resected specimens according to the new (1987) TNM (tumor, node, metastasis) classification. Endosonography was accurate in the evaluation of the depth of tumor infiltration. Overall accuracy for common bile duct carcinoma and common hepatic duct carcinoma was 82.8% and 85%, respectively. Endosonography was helpful in diagnosing regional lymph node metastases but not accurate in diagnosing nonmetastatic lymph nodes. With common bile duct carcinoma, the incidence of lymph node metastasis increased with progressive depth of tumor infiltration. No such correlation was found in common hepatic duct carcinomas. In the staging of distant metastasis, this technique was limited by the low-penetration depth of ultrasonography. Thus, additional transcutaneous ultrasonography or computed tomography was necessary for complete staging. The routine use of the biopsy channel for endosonographically guided aspiration puncture will further enhance the diagnostic value of endosonography in the future.
Does metoclopramide reduce the length of ileus after colorectal surgery? A prospective randomized trial. Between August 1988 and September 1989, 100 consecutive patients who underwent elective abdominal colorectal surgical procedures were prospectively randomized to receive or not to receive metoclopramide. Metoclopramide was intravenously administered every 8 hours from the completion of surgery until a solid food diet was able to be tolerated. Seven patients were not included in the final tabulations because of one death, one small bowel obstruction requiring laparotomy, one anastomotic leak requiring laparotomy, and four protocol violations. Ninety-three patients, 37 men and 56 women (mean age, 59.5; range, 14-89 years) underwent 40 segmental colectomies, 13 total abdominal colectomies, 8 abdominoperineal resections, 8 ileoanal pouch procedures, 7 small bowel resections, and 17 other colorectal procedures. The 40 patients who received postoperative metoclopramide were in Group 1, and the 53 who did not were in Group 2. The mean length of time between laparotomy and commencement of oral fluid and oral solid intake in Groups 1 and 2 were 3.5 and 4.8 days, and 3.5 and 5.0 days, respectively. These differences were not statistically significant (P greater than 0.05). Prolonged ileus was seen in seven patients in Group 1 and in eight patients in Group 2. These differences were also not statistically significant (P greater than 0.05). Prolonged ileus was defined as the need for nasogastric tube reinsertion or discontinuation of oral intake. We conclude that metoclopramide does not significantly alter the course of postoperative ileus.
Bleeding complications to oral anticoagulant therapy: multivariate analysis of 1010 treatment years in 551 outpatients. One thousand and ten patient years of oral anticoagulant therapy with vitamin-K-antagonists were reviewed with regard to major bleeding complications. The incidence of bleeding that necessitated hospital admission was 2.7% per year (95% confidence limits, 1.7-3.7%). The major source of bleeding was the alimentary tract, whereas no cases of intracranial bleeding were found. Various factors with potential effects on the bleeding risk were evaluated by multivariate statistical analysis, and the following independent risk factors were identified: age greater than 75 years and hypertension increased the bleeding risk by 10.5% and 4.5%, respectively. Each recorded prothrombin value significantly below the therapeutic range increased the bleeding risk by 3.9%, and each year of treatment increased the risk by 2.0%. These figures may be used to estimate the risk of major bleeding in an individual patient. Current treatment with thiazide diuretics was found to increase the bleeding risk by 5.2%. However, this observation requires further documentation and analysis. Although no lethal episodes of bleeding occurred, the developing field of indications for oral anticoagulant therapy should be considered on the basis of a continuous substantial risk of major bleeding.
Malakoplakia of the temporal bone in a nine-month-old infant. A case of malakoplakia, of the temporal bone in a nine-month-old male child is reported. The lesion presented as an aural polyp, associated with a lower motor neuron facial palsy. On exploration, the granuloma was noted to involve the temporal bone, eroding the bony labyrinth. It was successfully treated with surgical debridement, and antibiotics. A review of the relevant literature is presented.
British Columbia sends patients to Seattle for coronary artery surgery. Bypassing the queue in Canada. Concern about waiting lists for elective procedures has become a highly visible challenge to the universal health insurance program in Canada. In response to lengthening queues for patients waiting for cardiac surgery, British Columbia made contracts with four Seattle hospitals to send a total of 200 patients for coronary artery bypass surgery. This article examines the cause of the queue for cardiac surgery in British Columbia and the events that led to outside contracting. Global hospital budgets and restrictions on capital expansion have limited hospital capacity for cardiac surgery. This constrained supply, combined with periodic shortages in critical care nurses and cardiac perfusion technologists, has resulted in a rapid increase in the waiting list. Reducing wide variations in the lengths of queues for individual surgeons may afford an opportunity to reduce long waits. While the patient queue for cardiac surgery has sparked a public debate about budget limits and health care needs, its clinical impact remains uncertain.
Double-blind, cross-over study comparing prostaglandin E1 and papaverine in patients with vasculogenic impotence. Intracorporeal injection of vasoactive agents is the treatment of choice for many patients with organic impotence. However, some patients with vasculogenic impotence respond poorly to injections of papaverine or papaverine/phentolamine. This study was conducted to determine if patients with vasculogenic impotence who failed to respond to papaverine might respond to prostaglandin E1 and thus be salvaged from possible prosthetic surgery. A total of 54 patients with vasculogenic impotence were administered intracorporeal prostaglandin E1 (20 micrograms) and intracorporeal papaverine (60 mg) randomized in a double-blind fashion and crossed over one week later. Forty-six percent of patients receiving prostaglandin E1 produced a satisfactory erection compared with 14 percent of patients with a similar response to papaverine. The difference between these results was highly significantly by the McNemar test. The number of side effects were similar for both drugs. Prostaglandin E1 might be considered the intracorporeal agent of choice for patients with significant vasculogenic impotence.
Hidradenoma papilliferum of the upper eyelid arising from the apocrine gland of Moll. Hidradenoma papilliferum is derived from apocrine sweat glands and was originally described as a tumor located in the anogenital area. The authors recently examined a 78-year-old man with a hidradenoma papilliferum at the margin of the upper eyelid. While the tumor was located in the dermis, serial sections showed a connection to the epidermis and neoplastic cells partially replacing a gland of Moll. There were glandular structures with luminal cells that showed apical decapitation-type secretion, indicating the apocrine origin of the tumor. The luminal cells also contained granules that stained with periodic acid-Schiff (PAS) stain and were diastase resistant. Results of examination of the duct-forming cells by transmission electron microscopy showed adluminal villi, focal decapitation secretion, luminal cytoplasmic debris, and electron-dense cytoplasmic secretory granules. Because the apocrine glands of Moll are localized adjacent to the eyelid cilia, hidradenoma papilliferum and other tumors of apocrine origin should be considered in the clinical setting of a mass at the eyelid margin.
'Low sodium' diuresis and ileal loss in patients with ileostomies: effect of desmopressin. Patients with ileostomies show an early diuresis when sodium restricted; this, together with an obligatory ileal sodium loss, predisposes them to severe salt and water depletion. The role of arginine vasopressin in this circumstance and whether it is natriuretic, or antinatriuretic, is unclear. There is also controversy over its likely effect on small bowel fluid reabsorption. We have examined the effect of the non-pressor (V2) synthetic vasopressin analogue 1-deamino-8-D-arginine (desmopressin) on renal and ileal sodium and water excretion in ileostomy patients during acute adaptation to a low sodium diet. Patients were studied on two separate occasions (nonrandomised) with and without the administration of desmopressin (0.75 micrograms intramuscular, three times a day). In eight subjects without desmopressin there was pronounced diuresis on the first low sodium day, associated with a fall in renal sodium excretion and no change in ileal output or composition. In five (of the original) subjects with desmopressin there was pronounced antidiuresis, no change in renal sodium excretion, and no change in ileal output or composition. In both studies rises in plasma renin activity and salivary aldosterone concentration lagged behind the early decline in renal sodium excretion. We have confirmed the phenomenon of 'low sodium' diuresis after sodium restriction in ileostomy patients and shown that it can be prevented by desmopressin. Desmopressin has no direct or indirect effect on renal sodium excretion or ileal fluid and electrolyte loss in humans.
Diagnostic accuracy of temporomandibular joint lower-compartment arthroscopy using an ultrathin arthroscope: a postmortem study. Arthroscopy was performed on the lower temporomandibular (TMJ) joint compartment of 30 fresh cadavers using a newly developed ultrathin arthroscope. Comparison of arthroscopic and dissection findings showed a diagnostic accuracy of 57%. There were both false-positive and false-negative arthroscopic diagnosis. The majority of the false diagnosis occurred in the lateral part of the joint. Iatrogenic damage to the disc occurred in one joint. The study suggests that arthroscopy of the lower joint space of the TMJ can be done with a diagnostic accuracy similar to what has been described for the upper joint space. There appears to be no major risks of iatrogenic damage to the joint structures using an ultrathin arthroscope.
Treatment of peptic ulcer disease with sucralfate: a review. Sucralfate has been used widely for the treatment of peptic ulcer. Healing rates for duodenal ulcer range from 60 to 90% at 4-6 weeks and up to 90% at 12 weeks for gastric ulcer. The small number of maintenance trials suggest that relapse of duodenal ulcer is reduced comparably to H2 receptor antagonists. There has been considerable interest in the possibility of lower relapse ratios after initial healing with sucralfate compared with H2 receptor antagonists, but more studies of the possible mechanisms as well as larger trials are still needed to confirm these observations.
Prevalence of HIV antibody in a noninner-city university hospital emergency department. STUDY HYPOTHESIS: To determine the prevalence of antibody to human immunodeficiency virus (HIV) in trauma and nontrauma patients not identified as having known HIV infection in a noninner-city university teaching hospital emergency department, and to determine the frequency with which treating emergency physicians are knowledgeable of patients' risk factors for HIV infection. POPULATION: ED patients between 18 and 59 years old with injuries that met trauma center triage criteria or with nontrauma-related illness who had blood drawn for physician-requested laboratory tests and for whom an extra aliquot of blood was available for HIV antibody testing. METHODS: All serum samples were first tested for antibody to HIV by enzyme-linked immunosorbent assay. If positive, the specimen was retested. All repeatedly reactive specimens were analyzed by Western blot test. The treating physician completed a questionnaire regarding the patient's illness and risk factors for HIV infection after the patient's care was completed. RESULTS: Two of 100 major trauma patients (confidence interval, 0% to 5%) and seven of 100 nontrauma patients (confidence interval, 2% to 12%) had antibody to HIV. The seropositive rate by age and clinical group varied from 0% to 12.5%, with the highest rates in the 30- to 39-year-old group of nontrauma patients. The difference in proportions of seropositivity between the sexes was not statistically significant. Physicians obtained information regarding homosexual or bisexual behavior, IV drug use, and hemophilia from 52% of the nontrauma patients and only 17% of trauma patients. None of 30 trauma patients for whom data were available and only two of the 100 nontrauma patients gave a history of any high-risk behavior. CONCLUSION: Although the sampling technique we used has limitations, the prevalence of HIV infection in our noninner-city ED is similar to that recently reported from inner-city EDs. This is in contrast to previous reports of low rates of HIV infection among ED patients in nonurban settings. Physician assessment of risk factors was incomplete in the majority of our patients. Patients rarely acknowledged any high-risk behavior. It is essential that emergency health care workers take maximum diligence to prevent exposure to blood and other body fluids from all ED patients.
Immune dysfunction in mice with plasmacytomas. I. Evidence that transforming growth factor-beta contributes to the altered expression of activation receptors on host B lymphocytes. Plasmacytoma-bearing mice (PC-mice) develop a polyclonal B cell immunodeficiency syndrome characterized by marked impairment of: a) primary antibody responses and b) proliferative responses to B cell mitogens. The present investigations used two-color flow cytometry to examine B lymphocytes from the spleens and lymph nodes of PC-mice and found decreased surface membrane expression of surface IgM (sIgM), transferrin receptors (TfR) and IgE FcR (CD23), increased expression of class II MHC, but normal expression of B220, Mel-14, Fc gamma RII, and Fc mu R. These changes were not related to the H chain class or the amount of Ig produced by the plasmacytoma. When cultured with IL-4, B lymphocytes from PC-mice increased their expression of sIgM and class II MHC, but not of CD23. Several findings implicate transforming growth factor-beta 1 (TGF-beta 1) in the mechanism that modulates receptor expression on B lymphocytes in PC-mice: a) ascites fluid from PC-mice contains large quantities of TGF-beta 1; b) supernatants of cultured spleen cells from PC mice contain up to eightfold more TGF-beta than is found with normal spleen cells; c) cloned plasmacytoma cells produce TGF-beta in vitro; and d) the abnormal phenotype of B cells from PC-mice, i.e., decreased CD23, sIgM, and TfR, and increased class II MHC, is induced on normal B cells cultured in the presence of TGF-beta 1. Because sIgM, TfR, class II MHC, and CD23 are molecules that play fundamental roles in the activation of normal B cells, their modulation by TGF-beta 1: a) identifies molecular mechanisms that could account for some of the known immunosuppressive properties of TGF-beta 1 and b) implicates TGF-beta in the pathogenesis of the polyclonal B cell immunodeficiency that is characteristic of plasma cell tumors.
Endoscopic removal of inflammatory fibroid polyps of the stomach. Three cases of gastric inflammatory fibroid polyp removed by endoscopic polypectomy are reported. All lesions were located in the gastric antrum or prepyloric region, and their depth was restricted to the submucosa. The correct diagnosis was obtained, and the digestive symptoms disappeared after polypectomy. In contrast to observations in previous reports, we believe these lesions are suitable for removal by endoscopic means, provided they are small in size and strictly submucosal in location.