shukoor65/lab-rag-model huggingface dataset:
Thrombolysis in refractory unstable angina. Multiple drug therapy, including nitrates, beta blockers, calcium antagonists, aspirin, and heparin, has been advocated as effective in the treatment of unstable angina, a syndrome with a multifactorial pathogenesis. Recently, plaque rupture and thrombosis have been demonstrated as the most important pathogenetic mechanisms. Nevertheless, clear-cut results on the effects of thrombolytic treatment in unstable angina are still lacking. Some possible explanations why the medical treatment of unstable angina has still not yet been standardized, whereas that of myocardial infarction has, are suggested. A review of randomized and nonrandomized studies published on this topic evaluating the role of different thrombolytic agents in unstable angina is presented. In addition the role of coronary angiography is discussed. In view of the disappointing results of coronary artery bypass surgery performed in the acute phase of the disease, one of the goals of clinical research is to identify subsets of patients at high and low risk and who undergo different types of therapeutic interventions. To support published data suggesting that total myocardial ischemia has a significant impact on prognosis, we present our results of a study carried out on patients with refractory unstable angina treated with thrombolytic therapy and evaluated with continuous electrocardiographic monitoring in the attempt to correlate total myocardial ischemia with short-term prognosis. Data in favor of the prognostic role of continuous electrocardiographic monitoring in unstable angina are also reviewed. Finally, we propose some suggestions that might be useful for future studies.
Natural history of the eosinophilia-myalgia syndrome. OBJECTIVE: To describe the natural history and disease progression of the eosinophilia-myalgia syndrome and to assess the therapeutic effects of orally administered steroids on the disorder as of October 1990. DESIGN: Case-series analysis. A cohort of 45 patients with the eosinophilia-myalgia syndrome was followed prospectively by periodic telephone interviews and medical examinations for an average of 14 months after onset of illness. SETTING: Washington state. PATIENTS: The cases of 47 patients were reported to the Washington State Department of Health from 1 July to 12 December 1989. Two patients were unavailable for follow-up, and the remaining 45 completed the study. MAIN RESULTS: Patients were predominantly non-Hispanic white women (87%) with an average age of 49 years. Symptoms typically progressed from early onset of myalgia and fatigue to later development of neurologic and scleroderma-like skin changes. Six (13%) patients recovered completely within 2 to 5 months of symptom onset. After 14 months of illness, over half of the patients who initially presented with myalgia, fatigue, or scleroderma-like skin changes remained symptomatic. The average severity of each major symptom was measured using interviews and patient self-reports and has improved subjectively by at least 40%. Statistical analyses showed no significant difference in long-term symptom duration or severity between patients treated and those not treated with prednisone. CONCLUSIONS: The eosinophilia-myalgia syndrome is a long-term illness characterized by progressive improvement during the first 25 weeks after symptom onset, followed by a protracted phase of symptom resolution. We could not show a clear-cut benefit of prednisone in reducing the long-term severity or duration of the disease.
Interpretation of the alveolar-arterial oxygen difference in patients with hypercapnia. According to conventional wisdom the difference between alveolar and arterial O2 tensions, the AaPO2, should distinguish between hypoxemia caused by alveolar hypoventilation and hypoxemia caused by alveolar hypoventilation complicated by other abnormalities of gas exchange. To test this concept we have calculated the AaPO2 from arterial blood gas measurements, breathing air, in 23 patients with hypercapnia, hypoxemia, and advanced obstructive lung disease (mean FEV1 = 0.88 L). We found that AaPO2 varied inversely with PaCO2 (r = -0.83, p less than 0.001). In five of these patients with the most severely elevated PaCO2 (range, 59 to 81 mm Hg) the AaPO2 was within normal limits. We also calculated the difference between the O2 contents of "ideal" pulmonary capillary blood and arterial blood and expressed this as the venous admixture (QVA/QT) based on an assumed arteriovenous content difference of 4.5 ml/dl. In contrast to the AaPO2, the QVA/QT, was abnormal in all patients (mean = 41 +/- 8%). We conclude that the AaPO2 may be an unreliable indicator of abnormal gas exchange in the presence of alveolar hypoventilation. This finding can be explained by substantial changes in the position of the alveolar and arterial points on the oxygen dissociation curve for hemoglobin in the presence of alveolar hypoxia secondary to hypoventilation.
Preoperative prostate-specific antigen in predicting pathologic stage and grade after radical prostatectomy. Preoperative serum prostate-specific antigen (PSA) was measured in 63 men who had clinically localized, previously untreated adenocarcinoma of the prostate and underwent subsequent radical prostatectomy and bilateral pelvic lymph node dissection. Pathologic stage and grade were correlated to the serum PSA value. Patients with organ-confined (P1, P2) and extracapsular (P3, P3N +) prostate cancer had elevated preoperative serum PSA levels (greater than 4 ng/mL) in 61 and 90 percent of cases, respectively. Patients with low-grade and high-grade tumor histology had elevated preoperative PSA levels in 62 and 80 percent of cases, respectively. In distinguishing between organ-confined and extracapsular disease with a preoperative serum PSA of 10 ng/mL as a cutoff value, the sensitivity was 68 percent, the specificity was 66 percent, the positive predictive value was 46 percent, and the negative predictive value was 83 percent. Although there was a trend of increasing preoperative serum PSA levels with higher pathologic stage or grade, there was no significant difference in preoperative serum PSA values with pathologic stage and/or grade considered as a group or in determining stage and/or grade preoperatively on an individual basis.
A population-based study on the incidence and survival rates of 3857 glioma patients diagnosed from 1953 to 1984. Intracranial glioma was diagnosed during the patient's life and histologically verified in 3857 patients between 1953 and 1984 in Finland. Their survival up to the end of 1987 was analyzed, the follow-up being complete. The treatment was by operation in 1193 cases, radiation in 459 cases, both operation and radiation in 1486 cases, and neither operation nor radiation in 719 cases. The 1-year, 5-year, 10-year, and 15-year cumulative relative survival rates were 0.53, 0.29, 0.20, and 0.18, respectively. The newborn to 14-year-olds lost 56% of their life expectancy; the 15-year-olds to 44-year-olds, 71%; the 45-year-olds to 64-year-olds, 88%; and the 65-year-olds to 99-year-olds, 91%. According to the model with the best fit in regression analysis the prognosis was significantly better among young, recently diagnosed patients who had undergone both operation and radiation.
Thermal effects and histologic changes from Nd:YAG laser irradiation on normal and diseased aortic tissue using a novel angioplasty catheter with a mobile optical fiber: an in vitro assessment. Although various laser angioplasty devices are currently being examined, thermal damage and perforation of the vessel wall remains the major acute complication of vascular laser recanalization. Consequently, the aim of this study was to investigate the thermal effects and histologic changes from laser irradiation (Nd:YAG, 1064 nm) on normal and diseased aortic tissue using a novel angioplasty device. During laser emission the coaxially guided optical fiber tip was positioned in reference to the end hole of the metallic capped probe as follows: (1) at the end hole (metal-cap position), (2) protruding 10 mm from that end hole (bare-fiber position), (3) withdrawn 5 mm into the metal cap's lumen (hot-tip position). In total, 96 laser impacts (25 joule: 5 W, 5 s, each) were produced on normal and atherosclerotic aorta in air through a 0.2-mm-core-diameter silica quartz fiber, with direct contact on the intimal surface of the target tissue by both the fiber and the metal cap and by either the fiber or the metal cap (n = 32 each). Tissue temperature was measured by means of special sensors positioned opposite the irradiated intimal spot in direct contact with the adventitial surface. Morphohistologic evaluation of lesions was performed and injury indexes were determined.
Use of a chlorhexidine dressing to reduce microbial colonization of epidural catheters. We performed a prospective randomized controlled trial to assess the efficacy of a chlorhexidine dressing in reducing the microbial flora at the insertion site of epidural catheters. These catheters were used for acute pain management and were dressed either by a standardized method or with a CHX/urethane sponge composite. Microbial colonization of the catheter developed in 9 of 31 controls (29.0%) and 1 of 26 (3.8%) catheters with the CHX dressing (P less than 0.05%). The CHX dressing caused no adverse effects. The data suggest that delivery of antiseptic to the catheter wound site reduces catheter colonization with a possible reduction in the risk of epidural catheter-related infection.
Development of human neural transplantation. The possibility of altering the course of Parkinson's disease by brain grafting is slowly becoming a reality through the efforts of many research groups worldwide. It has been shown that this procedure, as performed in high-level medical research centers, usually produces no permanent adverse effects and can effectively ameliorate parkinsonian signs in certain patients. This progress has served to reinforce our commitment to develop neural transplantation into an effective therapy to treat such a devastating neurodegenerative disease. We have summarized the most important events that have shaped the initial phase of this research. In the course of the last 4 years, considerable knowledge has been gained in the clinical neurosciences regarding the real potential of various brain grafting procedures in treating Parkinson's disease, their shortcomings, and their usefulness in carefully selected patients. There is still no consensus regarding the various fundamental aspects of human brain grafting in Parkinson's disease. Questions concerning surgical technique, candidate selection, the optimal brain regions for implantation, the optimal tissue for implantation, and the real usefulness of brain grafting must be addressed. The importance of the quality of adrenal medulla fragments for grafting, the requirement for immunosuppressors in fetal brain grafting, and the optimal fetal age and the amount of donor tissue for effective grafting are additional areas of concern. The potential of xenografting, preserved tissues, and genetically engineered cells for human brain grafting remain unanswered. The development of human neural transplantation is the responsibility and privilege of neurosurgery.
Peritoneal endometriosis: endometrial tissue implantation as its primary etiologic mechanism. The mechanisms involved in primary implantation of pelvic endometriosis were investigated in women undergoing laparoscopy as part of an infertility evaluation. Among the women with a diagnosis of endometriosis, those with no observed lesions in the ovaries and no adhesions in the pelvic cavity were classified as being in stage I. These women were further subdivided into two groups: the stage Ia group in which implants were found in one area (25 women) and the stage Ib group in which implants were found in two or more areas (29 women). In both groups the most frequent site was the uterosacral ligaments followed by the posterior uterine serosa, the posterior cul-de-sac, and the posterior broad ligaments in that order. Regardless of the position of the uterus, endometriosis was found significantly more frequently in the posterior compartment. The finding that the most frequent implants on the uterosacral ligaments were near the tubal ostium and, in the stage Ia group, the absence of implants on the anterior uterine serosa but a 33% frequency on the posterior uterine serosa, which is more frequently exposed to menstrual blood, suggest that implantation of endometriosis is the result of retrograde menstruation. However, the possibility that metaplasia of the serosal epithelium is stimulated by menstrual blood cannot be ruled out, inasmuch as the process of implantation in the peritoneum has not yet been proved.
Experimental hemorrhage and blunt trauma do not increase circulating tumor necrosis factor. Tumor necrosis factor (TNF) is a potent cytokine mediator of the shock states associated with sepsis and burn injury. This experimental study was done to determine whether circulating TNF plays a major role in the vasomotor collapse seen following experimental hemorrhage and blunt injury. Twenty anesthetized pigs were divided into two groups. Ten animals were bled 60% of their calculated blood volume in 15 minutes. Animals in Group IA (n = 5) had no treatment, and Group IB animals (n = 5) were given twice the shed volume as crystalloid 30 minutes after hemorrhage. The other animals, groups IIa and IIb (n = 5 each), were first subjected to a blunt injury to the thigh sufficient to cause a midshaft femur fracture, then bled and similarly treated. In both groups, mean arterial pressure (MAP), cardiac output (CO), and serum TNF activity by L929 bioassay were measured at 15-minute intervals for 120 minutes after hemorrhage or hemorrhage and blunt injury. An additional three animals were infused with 4 x 10(8)/kg heat-killed E. coli to validate the TNF assay. All bled animals sustained a fall in MAP and CO to a mean of 33% of baseline values, with or without fracture. Group IB and IIB animals responded to fluid resuscitation by restoration of MAP and CO to 85%-97% of the baseline values. Tumor necrosis factor was not detectable before injury and remained undetectable in all these animals during the 120 minutes of the experiment despite hemorrhage alone or combined hemorrhage and blunt trauma, with or without fluid resuscitation. The test animals receiving the E. coli responded with markedly elevated TNF levels, which peaked at 90 minutes after injection.
Effect of disc degeneration at one level on the adjacent level in axial mode. Nonlinear three-dimensional finite element models of a ligamentous two motion segments spine specimen (L3-L4-L5) were developed to investigate the effects of disc degeneration, simulated at the L4-L5 level, on the biomechanical behavior of the adjacent intact L3-L4 motion segment. The disc degeneration was simulated by removing the hydrostatic capabilities of the nucleus and making the L4-L5 disc stiffer than a normal disc. The results of the degenerated model were compared with the predictions for a model in which the L4-L5 disc was left intact. The loads on the facets decreased, and intradiscal pressure in the intact L3-L4 disc increased as a result of disc degeneration compared with the intact model. The predicted increase in the intradiscal pressure and the associated increase in the disc bulge in the posterior region over time may trigger the degenerative process at the L3-L4 motion segment. This is in accordance with the Wolff's law; living tissue responds to chronic changes in stresses and strains. The limitations of the present two motion segments model and the potentials of multisegmental models are discussed.
Cancer risk among staff at two radiotherapy departments in Denmark. In comparison with the general Danish population, the relative risk (RR) for cancer among staff members employed in two radiotherapy departments in Denmark during 1954-1982 and alive on 1 April 1968 was assessed by linkage to the Danish Cancer Registry. All staff had been monitored with film dosimeters for exposure to radiation. The study cohort consisted of 4151 persons, accruing 49553 person-years at risk. The collective radiation dose was 76.54 manSv and the mean dose 18.4 mSv. A total of 163 cancer cases were observed with 152.3 expected. The risks for cancers usually considered to be radiogenic were not elevated. A significant excess of prostatic cancer was observed (five cases, relative risk, 6.02; 95% confidence interval, 1.94-14.06); this is likely to be a chance finding. No relation was observed between radiation dose or years of exposure and cancer risk, but a weak non-significant increase in risk with time since first exposure was seen.
Wound complications after modified radical mastectomy compared with tylectomy with axillary lymph node dissection. Tylectomy with axillary lymph node dissection and radiotherapy (TAD) has become an accepted treatment for early breast cancer and has been shown to result in equal 5- and 8-year survival when compared with modified radical mastectomy (MRM). In order to determine the safety of TAD with respect to wound complications and to identify potential risk factors, we reviewed the charts of 560 patients undergoing MRM (n = 387) and TAD (n = 173) at Virginia Mason Medical Center from 1983 through 1989. The incidence of infection, seroma, hematoma, and epidermolysis were compared, and obesity, age 60 years or older, smoking, antibiotics, and wound drainage were examined as possible risk factors. There were more wound complications in the MRM group versus the TAD group (49% versus 35%; p less than 0.01), specifically more seromas (29% versus 18%; p less than 0.01) and epidermolysis (18% versus 0%). In the MRM group, age 60 years or older was associated with seroma (p less than 0.01) and smoking was associated with epidermolysis (p less than 0.01). In the TAD group, obesity was associated with infection. In both groups, volume of drainage from closed suction wound drains greater than 30 mL in the 24 hours prior to removal of the last drain was associated with seroma (p less than 0.05).
The NACI Registry: an instrument for the evaluation of new approaches to coronary intervention. The NACI Investigators. The New Approaches to Coronary Intervention (NACI) Registry was developed to collect in-depth data about patients whose coronary artery lesions are being treated with new interventional techniques such as atherectomy, stents, and laser devices. The NACI Registry database distinguishes among several possible "modes" for device use, such as preparatory, planned definitive, and bailout use. Common definitions are used for data collection across all devices, and device-specific forms are used to record procedural details. NACI's unique modular form design facilitates thorough data collection, even for the most complex treatment scenarios. The database structure allows for data analysis at the patient, procedure, lesion, and device levels, as required to perform in-depth analyses of the immediate and long-term success of new devices. Once adequate knowledge of basic device performance has been collected, the Registry structure can also allow expeditious planning and performance of randomized trials comparing a new device to conventional PTCA.
Transgenic oncogene mice. Tumor phenotype predicts genotype. The hypothesis that oncogenes influence tumor phenotype was tested by examining slides from 607 mammary tumors from 407 transgenic mice bearing the ras, myc, and/or neu oncogenes. Most tumors (91%) had patterns (phenotypes) that could not be classified by Dunn's standard nomenclature. The nonstandard tumors were described as eosinophilic small cell (SC), basophilic large cell (LC), or pale intermediate cell (IC). The SC tumor was associated with ras, the LC was associated with myc, and the IC was associated with neu, with specificities more than .90 and sensitivities ranging from .99 to .48. Thus, the tumor phenotype could be used to predict which oncogene was present in the animal. The presence of myc in combination with either ras or neu resulted in the predominance of LC tumors and accelerated tumorigenesis. The combination of ras and neu resulted in a decreased tumor incidence. Thus, knowledge of the oncogenes that were present could be used to predict the natural history of the disease.
Primary squamous cell carcinoma of the terminal ileum. A case of squamous cell carcinoma of the terminal ileum with no underlying duplication or inflammatory disorder is described. The neoplasm seemed to have originated from the surface epithelium, invading the wall and metastasising to the regional lymph nodes. The 65 year old patient was free of disease three years after having had the tumour removed. Previous reports of squamous carcinoma of the small intestine have been associated with intestinal duplication or metastatic disease from distant sites.
Induction of hemoglobin synthesis by downregulation of MYB protein with an antisense oligodeoxynucleotide. Reduced expression of the proto-oncogene c-myb appears necessary for erythroid differentiation induced by chemical agents and by the natural regulator, erythropoietin (Epo). Treatment of Epo-responsive Rauscher erythroleukemia cells with an anti-sense oligodeoxynucleotide to c-myb in the absence of other inducers downregulated myb protein markedly and caused hemoglobinization of the cells within 48 hours. Epo treatment, which downregulates c-myb in these cells, induced hemoglobinization to the same degree. Epo also induced the appearance of anion transport protein on the plasma membrane, consistent with terminal differentiation. In contrast, antisense c-myb did not induce this erythroid marker. The results are consistent with a role for myb protein in the regulation of hemoglobin synthesis.
Intratracheal injection of endotoxin and cytokines. II. Interleukin-6 and transforming growth factor beta inhibit acute inflammation. The nature of the endogenous mediators that down-regulate and curtail the exodus of neutrophils into local acute inflammatory sites is unknown. In the present report, interleukin-6 (IL-6) and transforming growth factor beta (TGF beta), members of a family of macrophage-derived proteins known as cytokines, are shown to inhibit significantly the acute neutrophilic exodus caused by an intratracheal injection of endotoxin (LPS), a proinflammatory component of the cell walls of gram-negative bacteria. Transforming growth factor beta (10 micrograms) and IL-6 (10 micrograms) coinjected intratracheally with LPS (10 micrograms) each inhibited the number of neutrophils in 6-hour bronchoalveolar lavage (BAL) specimens by approximately 50%. The intratracheal coinjection of IL-6, TGF beta, and LPS inhibited the LPS-induced neutrophilic inflammatory exodus by nearly 75%. Interleukin-6 also is shown to be endogenously upregulated within the lung after intratracheal challenge with endotoxin, providing evidence that IL-6 may represent an endogenous negative feedback mechanism to inhibit endotoxin-initiated cytokine-mediated acute inflammation. Interleukin-6 and TGF beta both strongly inhibited the quantity of TNF-alpha recovered in the BAL fluid of LPS-challenged rats, suggesting that downregulation of LPS-induced TNF-alpha production within the lung represents one mechanism whereby IL-6 and TGF beta exert an antiinflammatory action. Interleukin-6 and TGF beta represent novel pharmacologic and, probably, endogenous inhibitors of acute inflammation.
Multiple pilomatricomas and myotonic dystrophy. Multiple pilomatricomas are rare. However, among patients with myotonic dystrophy, the occurrence is higher. The authors report a patient, to their knowledge the 11th case of multiple pilomatricomas associated with myotonic dystrophy, to emphasize that these tumors may be associated with the disease.