shukoor65/lab-rag-model huggingface dataset:
A critical review of the evidence supporting a relationship between impaired fibrinolytic activity and venous thromboembolism. We critically evaluated the evidence for an association between venous thromboembolism and impaired fibrinolytic activity, as determined by global tests of fibrinolytic activity or specific tests for tissue plasminogen activator and plasminogen activator inhibitor. A computer-assisted and manual search was performed to retrieve all articles that reported on fibrinolytic activity and venous thromboembolism. The strength of the evidence for an association was assessed by analysis of the design of individual studies with special attention directed to choice of controls and methods of diagnosis of venous thromboembolism. It is concluded that for patients with symptomatic thrombosis the published evidence does not prove an association between impaired fibrinolytic activity and increased risk of thrombosis. In contrast, for postoperative thrombosis there is good evidence for an association between impaired fibrinolytic activity measured either preoperatively or postoperatively and increased risk of postoperative thrombosis. Whether this association is causal or coincidental is unclear, since randomized clinical trials that used interventions to enhance fibrinolytic activity produced inconsistent results.
Comparison of computerized tomography and magnetic resonance imaging for the postoperative assessment of residual acoustic tumor. Ten patients with surgically confirmed residual cerebellopontine angle neuromas, imaged by both computerized tomography (CT) with iodine contrast and magnetic resonance (MR) with and without gadolinium enhancement, are reviewed to identify the strengths and limitations of MR as compared with CT imaging. MR imaging offers superior anatomic resolution in multiple imaging planes without ionizing radiation, but it is expensive and has adverse effects on some patients. CT imaging offers good anatomic resolution, but in only one or two planes. CT is both less expensive and generally well tolerated, but allergy to the iodine contrast is not uncommon. The cases presented demonstrate the adequacy of CT imaging of residual tumor. However, in some cases MR imaging provided important additional detail. MR imaging also demonstrated postoperative changes within the brain stem and cerebellum. In our experience, CT imaging remains a satisfactory, unambiguous approach to the assessment of known postoperative residual cerebellopontine angle neuromas. MR imaging provides superior resolution, however, and should be used when better definition of tumor detail is needed for management decisions or when multiple follow-up scans are anticipated, so that the exposure to ionizing radiation is limited. MR is also useful to investigate postoperative neurologic dysfunction. Postoperative changes and residual tumors are more difficult to interpret on MR than on CT. Guidelines are proposed to help distinguish residual tumor from postoperative changes and scarring.
The high risk of death by alcohol related diseases in subjects diagnosed as diabetic and impaired glucose tolerant: the Paris Prospective Study after 15 years of follow-up. The 15 year mortality rates and causes of death are reported for the Paris Prospective Study cohort of 7180 working men, aged between 44 and 55 years who attended the first follow-up examination. All subjects were classified as normoglycaemic, impaired glucose tolerant or diabetic according to the WHO criteria, following an oral glucose tolerance test. The relative risks of death in comparison to the normoglycaemic group were 1.6 for impaired glucose tolerant and 2.3 for diabetic subjects; for death due to coronary heart disease: 1.7 and 2.3 respectively; for death due to alcohol and cirrhosis: 7.0 and 13.3 respectively. It appears that in this cohort a proportion of subjects screened as diabetic have impaired liver function and disturbed carbohydrate metabolism, due to excessive alcohol consumption. Alcohol should be investigated as a possible risk factor for diabetes, particularly in epidemiological studies where diabetes is diagnosed by the oral glucose tolerance test and the population has a high consumption of alcohol.
Prevalence of liver disease in cystic fibrosis. To assess the prevalence, demography, and clinical features of liver disease among patients with cystic fibrosis the case notes of 524 patients of all ages who were attending the cystic fibrosis clinic were studied. Computer databases were used to establish the condition of the liver in a further 576 such patients. The overall prevalence of overt liver disease indicated by the presence of an enlarged liver or spleen (or both) was 4.2%. The age related prevalence rose to a peak in adolescence, and then fell in patients over 20 years old. The implied increase in mortality among those with liver disease was not explained by deaths from liver disease, which were rare. Male patients were significantly more affected than female, the ratio being 3:1 among adolescents. Increasing prevalence of liver disease in patients with cystic fibrosis is, therefore, not just a result of longevity.
Flow cytometric analysis of nuclear DNA content in advanced gastric cancer and its relationship with prognosis. Cell nuclear DNA content was determined by flow cytometric analysis in 270 patients with deeply infiltrating (beyond the submucosa) cancer, so-called advanced gastric cancer. Aneuploidy was observed in 150 cases (55.6%). Multivariate analysis showed that the DNA ploidy pattern was the third significant prognostic factor behind peritoneal dissemination and liver metastasis. The 5-year survival rate of diploid patients (62.9%) was significantly higher than that of aneuploid patients (22.7%) (P less than 0.01). This trend was most clear in patients with Stage III and IV tumors. Among aneuploid cases the high DNA index group indicated a worse prognosis than the low DNA index group. It was thus assumed that the DNA ploidy pattern was a useful prognostic indicator of advanced gastric cancer.
Endometrial carcinoma in the cancer family syndrome. The study group consisted of 26 women with endometrial adenocarcinoma belonging to 19 cancer families. Age at the onset of cancer, the stage and histologic differentiation of the tumor, initial symptoms, other malignancies, 5-year survival, and transmission of cancer to descendants were studied. The focus was on the importance of endometrial carcinoma in the tumor spectrum. The diagnosis of cancer family was delayed in 14 of the 19 families because endometrial carcinoma was not included in the primary diagnostic carcinoma. This delay may have been harmful to 16 family members who had carcinomas later in life. In ten of the 14 women with multiple malignancies, endometrial adenocarcinoma was the primary malignancy diagnosed, thus enabling the suspicion of a gene carrier and screening for subsequent malignancies. The authors concluded that endometrial carcinoma is a significant component of cancer family syndrome and should be included in the main criteria of Lynch syndrome II.
Simultaneous occurrence of cutaneous T cell lymphoma and low-grade B cell lymphoproliferative diseases. A report of two cases. Two previously unreported patients with cutaneous T cell lymphoma associated with systemic low-grade B cell proliferations are presented. The first patient had Waldenstrom's macroglobulinemia and the second had simultaneous chronic lymphocytic leukemia. The use of immunosuppressive drugs or a genetic predisposition may have contributed to the second malignancy. However, the possibility that malignant helper/inducer T lymphocytes were a factor in the promotion of the proliferation of B cells cannot be excluded.
Placental examination in a clinical setting. Placental examination has been proved to be of clinical value in cases selected because of gestational complications, unusual disorders of mother or infant, perinatal death, problems in perinatal diagnosis, and multiple pregnancy. Ten percent to 15% of births meet these criteria for selection. Causes of perinatal death, such as placental abruption, cord accidents, placental infarction, infection, and hematologic disorders, have been demonstrated. Clinically occult abnormalities, including chronic infections, maternal vascular disease, neoplasms, and storage diseases, have been recognized. Amniotic lesions and single umbilical artery have directed attention to fetal malformations. Monozygosity has been documented by monochorionic placentation. As a diagnostic source, the placenta has contributed to clinical care, understanding of disabilities among surviving children, and insight of forensic value. Limitations of placental studies stem from their qualitative nature and from gaps in current knowledge of gestational pathophysiology.
Monomelic amyotrophy in siblings. Monomelic amyotrophy is a rare, benign motor neuron disorder. Electrophysiologic studies are suggestive of localized chronic anterior horn cell disease. Two young siblings are reported with monomelic amyotrophy who had proximal muscle weakness confined to one arm. We propose that monomelic amyotrophy, at least in this family, is inherited as an autosomal recessive trait.
Right- and left-arm blood pressure discrepancies in vascular surgery patients. To identify a relationship between atherosclerotic vascular disease and differences in blood pressure between the right and left arms, blood pressure differences between arms were measured in patients with peripheral vascular disease (PVD, n = 58), in patients with coronary artery disease (CAD, n = 38), and in patients with no evidence of atherosclerotic disease, who served as a control group (n = 38). The incidence and magnitude of right and left arm pressure difference determined by the oscillometric technique were compared between the patient groups. The incidence of systolic pressure difference greater than or equal to 20 mmHg between arms in patients with PVD (21%) was greater than that in either those with CAD (3%) (P less than or equal to 0.05) or control subjects (0%) (P less than 0.01). The incidence of systolic pressure difference greater than or equal to 45 mmHg between arms in patients with PVD (10%) was greater than that in either those with CAD (0%) (P less than 0.05) or control subjects (0%) (P less than 0.05). Patients with PVD also had a greater incidence of right and left arm difference than did those with CAD or controls for mean and diastolic blood pressures. Of all patients with a systolic difference greater than 10 mmHg, neither the right nor the left arm blood pressure was consistently higher: 21 of 35 (60%) had a higher pressure in the right arm, and 14 of 35 (40%) had a higher pressure in the left arm (P = 0.33). Gender, diabetes, hypertension, smoking, and age were not associated with a difference in blood pressure between the right and left arms.
The origin of symptoms on the brain-gut axis in functional dyspepsia. It was hypothesized that symptoms in functional dyspepsia are originated by an altered mechanism at the brain-gut axis (one or several) in the process of gastric accommodation to a meal. To test the key mechanisms potentially involved in symptomatic gastric accommodation, the sensorial responses (on a 0-10 perception score) and the gastric tone responses (by electronic barostat) to either gastric accommodation (n = 10) or to cold stress (n = 10) were measured in 20 patients with functional dyspepsia and 20 healthy controls. The mechanical accommodation of the stomach to gastric distention (compliance) was similar in patients (52 +/- 8 mL/mm Hg) and controls (57 +/- 6 mL/mm Hg). However, isobaric gastric distention elicited more upper abdominal discomfort in dyspeptics than in controls (perception scores, 4.7 +/- 0.9 vs. 1.1 +/- 0.5, respectively; mean +/- SE; P less than 0.005). Cold stress induced a similar gastric relaxatory response in dyspeptics and controls (delta vol, 145 mL +/- 40 mL vs. 141 mL +/- 42 mL, respectively); hand perception (scores, 8.3 +/- 0.4 vs. 7.9 +/- 0.4, respectively) and autonomic responses were also similar. It is concluded that an abnormal afferent sensorial pathway (altered gastric perception) may be a major mechanism of symptom production in functional dyspepsia.
In vivo footprinting of MHC class II genes: bare promoters in the bare lymphocyte syndrome. Major histocompatibility complex (MHC) class II genes are coordinately regulated and show tissue-specific expression. With the use of in vivo footprinting, common promoter sites in these genes were found to be occupied only in cells that expressed the genes, in spite of the presence of the promoter binding proteins. In vivo analysis of mutant cell lines that exhibited coordinate loss of class II MHC expression, including several from individuals with bare lymphocyte syndrome, revealed two in vivo phenotypes. One suggests a defect in gene activation, whereas the other suggests a defect in promoter accessibility.
Neurenteric cyst located dorsal to the cervical spine: case report. A patient with a neurenteric cyst located dorsal to the cervical spine and associated with occult cervical spinal dysraphism is described. The embryological theories that might explain the occurrence of such a lesion are discussed.
Prevention of irradiation-induced bowel discomfort by sucralfate: a double-blind, placebo-controlled study when treating localized pelvic cancer. Sucralfate, an aluminum hydroxide complex of sulfated sucrose used in the treatment of gastric ulcer, was shown to prevent irradiation-induced diarrhea and bowel discomfort significantly in patients treated for pelvic cancer with external radiotherapy with intent to cure. The double-blind placebo-controlled study included 70 patients with carcinoma of the prostate and urinary bladder without distant metastasis (T1-4NO1xMO) and performance status of greater than or equal to 90% Karnofsky scale. Radiotherapy was administered in a conventional manner with MeV photons and a four-field technique. The total dose was 62-66 Gy and total treatment time of 6.5 weeks. Dose granules of sucralfate or placebo were dispensed to each patient 2 weeks after radiation started and continued for 6 weeks. All analyses were performed blindly. Seven of 34 evaluable patients in the placebo group and 18 of 32 evaluable patients in the sucralfate group did not present with diarrhea during the observation period. The frequency of defecation and stool consistency were significantly improved by sucralfate. Fourteen patients in the placebo group and only three in the sucralfate group required symptomatic therapy with loperamide. There was no evidence of adverse effects associated with the use of sucralfate. Sucralfate can be of beneficial value in diminishing the bowel discomfort during radiotherapy of pelvic malignancies, and the earlier proposed mechanisms of action (e.g., protection of denuded mucosa, cytoprotective properties, binding bile acids) can also be valid for the current effects of sucralfate.
Phosphate diabetes associated with bone metastases of oat cell lung cancer. Although the link between phosphate diabetes and neoplasm or benign mesenchymal tumors has been well documented, the nature of the phosphaturia factor remains unknown. We describe two cases of phosphate diabetes associated with bronchogenic cancer. In these case reports, we suggest that fibroblasts or osteoblasts synthesize a phosphate eliminating substance.
A mutant alpha subunit of Gi2 induces neoplastic transformation of Rat-1 cells. In a recently discovered class of oncogenes, GTPase-inhibiting mutations constitutively activate alpha subunits of signal-transducing guanine nucleotide-binding proteins (G proteins). Somatic mutations in a subclass of endocrine tumors are found in the arginine-179 codon of the alpha subunit of Gi2 (alpha i2), creating the putative gip2 oncogene. We have tested the ability of gip2 to mediate neoplastic transformation of Rat-1 and NIH 3T3 fibroblasts in tissue culture. Expression of a mutant alpha i2 cDNA encoding cysteine in place of arginine-179 (alpha i2-R179C) caused Rat-1 cells to grow to a higher density in monolayer culture, to lose anchorage dependence, and to form tumors when injected subcutaneously into nude mice. In contrast, expression of alpha i2-R179C failed to alter growth or tumorigenicity of NIH 3T3 cells. We conclude that gip2 is an oncogene, by the criterion that it induces neoplastic transformation of Rat-1 cells. Failure of gip2 to transform NIH 3T3 cells is in keeping with clinical indications that gip2 is a tissue-selective oncogene.
Colorectal cancer: cross-sectional imaging for staging of primary tumor and detection of local recurrence. This review describes the use of cross-sectional imaging in the staging of colorectal carcinoma and detection of local recurrence. The contributions of CT, MR imaging, and sonography are discussed and illustrated. Colorectal carcinoma is the second most common tumor in the United States and the most common cancer in the gastrointestinal tract. The prognosis for patients with this neoplasm is closely related to the extent of tumor at the time of diagnosis. Accurate noninvasive preoperative assessment of tumor stage by one or a combination of radiologic techniques would enable appropriate treatment to be planned in each case. Also, determination of possible tumor recurrence would permit effective monitoring of success of therapy and surgical intervention for recurrent disease before widespread metastasis occurs.
Stage IB squamous cell cancer of the cervix: clinicopathologic features related to survival. Three hundred forty-five patients with stage IB squamous cell carcinoma of the cervix were treated at the University of Michigan Medical Center from 1970 through 1985. The overall cumulative 5-year survival was 89%. The clinical characteristics included mean age 44.6 years, nulliparity 10%, married 93%, obese 38%, hypertension 32%, diabetes mellitus 5%, smoking 54%, symptoms of bleeding 68%, positive cytologic smear 83%. Lymph nodes were diseased in 45 of 261 (17%) with 26 unilateral (10%) and 19 bilateral (7%). Tumor differentiation showed: grade 1, 112 (33%); grade 2, 144 (42%); grade 3, 86 (25%). Factors that did not influence survival included age, presence or absence of positive cervical cytologic smear, the interval from previous papanicolaou smear, hypertension, smoking history, patient's blood type, and transfusion at radical hysterectomy. In all patients survival was significantly influenced by the following features: tumor classified as well differentiated (95%) or poorly differentiated (82%); tumor size less than 3 cm (91%) or greater than 3 cm (76%); negative lymph nodes (93%) or positive lymph nodes (61%). When three or fewer lymph nodes were involved, the survival was 79% compared with 33% when four or more lymph nodes were involved. In 213 patients undergoing radical hysterectomy the cumulative 5-year survival was significantly influenced by the amount of residual cervical disease: no residual disease, 100%; less than 50% penetration, 96%; greater than 50% penetration, 83%. Involvement of the lower uterine segment reduced survival to 73% compared with 95% when the lower segment was uninvolved. One hundred seventeen patients without angiolymphatic invasion had a 97% cumulative 5-year survival whereas 70 patients without disease in the lymph nodes but with angiolymphatic invasion had an 88% cumulative 5-year survival rate. A Cox model, multiple proportional hazard analysis was performed for all patients, and the factors that influenced survival included tumor grade, tumor size, presence of metastatic disease in the lymph nodes, and diabetes mellitus. In patients undergoing radiation therapy, the tumor grade and size were significant factors in survival. In patients undergoing radical hysterectomy, survival was influenced by the depth of cervical penetration and lower uterine segment involvement whereas the tumor grade, tumor size, patient's age, and removal of ovaries were not significant.
Adjuvant effect of human growth hormone with an inactivated flavivirus vaccine. Vaccines made by inactivating pathogenic microorganisms have been dramatically successful in controlling diseases in humans and animals. Despite their successes, they have a major disadvantage in that several inoculations are required for them to be effective. To overcome this problem, a commercial inactivated vaccine preparation against tickborne encephalitis was combined with human growth hormone (HGH). This formulation produced complete protection in a murine model with only one dose of vaccine, apparently by binding hormone and antigen to an insoluble matrix containing aluminium hydroxide. Thus it is postulated that when virus-specific lymphocytes are attracted to the site of injection, the hormone is at a high local concentration and stimulates the clonal expansion of antigen-specific T cells. The development of genetically engineered HGH now gives unlimited supplies of hormone, potentially resulting in an increase in efficacy of a wide variety of vaccines, especially those needing prolonged immunization schedules such as those being developed to combat human immunodeficiency virus infection.
The clinical management of cirrhosis. The discipline of hepatology is being rapidly advanced by several methods of investigation, most notably those of molecular and genetic biology. The polymerase chain reaction holds very great promise in unraveling the implications of hepatic virus infections. At the present time, we have no method of reversing established cirrhosis, and those with life threatening impairment of liver function can only look to liver transplants for salvage. The clinician can therefore best serve by identifying liver disease before cirrhosis and its complications occur. With effective case finding, and the continued development of therapeutic interventions directed toward known or suspected etiologic and pathogenic factors, many productive, high-quality years can be added to the lifespans of many patients.
Subretinal neovascularization in systemic lupus erythematosus. Choroidal involvement in systemic lupus erythematosus (SLE) occurs infrequently. We describe a patient with unusual manifestations of lupus oculopathy: prominent choroidal vasculopathy associated with multiple chorioretinal scars and subretinal neovascularization in the macular area. Choroidal disease was the primary feature of ocular involvement. SLE should be considered in the differential diagnosis in patients with inflammatory choroidal lesions.