shukoor65/lab-rag-model huggingface dataset:
Thrombolytic treatment in acute myocardial infarction: neutrophil activation, peripheral leucocyte responses, and myocardial injury. OBJECTIVE--To examine early leucocyte responses and neutrophil activation in acute myocardial infarction treated by streptokinase and to relate the findings to coronary recanalisation and indices of myocardial damage in order to provide further information about the role of neutrophils in the evolution of injury. DESIGN--Group analysis of paired blood samples, obtained before streptokinase treatment and one hour after it, and of three indirect measures of myocardial injury: left ventricular ejection fraction, QRS score, and peak creatine kinase. SETTING--The coronary care unit of a district general hospital. PATIENTS--39 patients with acute myocardial infarction who underwent paired blood sampling (before streptokinase and one hour after streptokinase) and cardiac catheterisation 5 (3-8) days later. END POINTS--Changes in peripheral white cell and neutrophil counts and plasma elastase one hour after streptokinase infusion. Comparison of these variables in patients with and without patency of the infarct related coronary artery. Correlations between these variables and indirect measures of myocardial injury. RESULTS--Neutrophil activation, as reflected by plasma elastase, increased sharply one hour after streptokinase. Total white cell and neutrophil counts also increased. Changes tended to be more pronounced in patients with patency of the infarct related artery, though the trend was not statistically significant. Neutrophil activation before streptokinase was unrelated to indirect indices of myocardial injury but only one hour after streptokinase a weak negative correlation with left ventricular ejection fraction had developed. Peripheral neutrophil responses showed a similar relation to ejection fraction and also correlated with peak creatine kinase and QRS score. CONCLUSIONS--Thrombolytic treatment in acute myocardial infarction is associated with an abrupt reactive neutrophil response which provides an early measure of injury. It is also associated with neutrophil activation, probably in response to coronary recanalisation and myocardial reperfusion. Activated neutrophils are recognised as mediators of reperfusion injury in experimental infarction and the data in the present study provide preliminary evidence of a similar pathogenic role in the clinical setting.
Expression of androgen receptor mRNA in human hepatocellular carcinomas and hepatoma cell lines. The expression of androgen receptor messenger RNA in hepatocellular carcinomas and hepatoma cell lines was studied using Northern-blot analysis and the complementary DNA-polymerase chain reaction method. Androgen receptor messenger RNAs were detected (although in low levels) in both hepatocellular carcinoma tissues and noncancerous tissues of the liver in all eight cases we studied, except for the tumor sample of one case. None of the hepatoma cell lines studied, however, expressed detectable levels of androgen receptor messenger RNA except for the SK-HEP-1 hepatoma cell line.
Depression and chronic fatigue in the patient with heart disease. Depression and chronic fatigue are frequently associated with heart disease. They may precede the onset of myocardial infarction, singly or together, and increase the morbidity and mortality of patients with a history of MI. Virtually all such patients have a transient depression, usually accompanied by anxiety, with onset soon after hospitalization. Although this depression is transient and usually abates spontaneously, it frequently warrants therapeutic intervention. Psychosocial and personality factors play a significant role in the recovery of a patient with a cardiac condition. The clinician must be alert for the effects of changing roles within the family and behaviors that may lead to chronic invalidism. Anxiety disorders, often combined with depression, may mimic cardiac disease and may result from it, leading to chronic fatigue and weakness. Proper diagnosis usually leads to considerable improvement. Cardiac drugs, in addition to many others, may produce depression and fatigue that may be misdiagnosed. Often, discontinuing or changing a medication will lead to marked diminution of such symptoms. Observational and listening skills are key ingredients of the "art" of medicine; they can lead to interventions that are not only therapeutic, but which improve the "quality" of life.
The prevention of the maternal manifestations of pre-eclampsia by intensive antihypertensive treatment. The purpose of the study was to determine if reduction of pregnancy hypertension to normal prevented the clinical maternal manifestations of pre-eclampsia. Thirty-six women with hypertension, but without proteinuria, were allotted at random to a test group of 17 who received intensive treatment, and a control group of 19 who were managed according to routine methods by hospital staff unconnected with the study. The development of proteinuria was chosen as an indicator of pre-eclampsia. Proteinuria developed significantly more often in the control group (in six of the 19 women) than in the test group (in one of the 17 women).
Percutaneous iliac artery stent: angiographic long-term follow-up. The authors conducted a prospective study of 49 consecutive patients with 53 lesions in 52 iliac arteries. All were treated between October 1987 and April 1990 with percutaneous transluminal angioplasty (PTA) and insertion of either a self-expandable or balloon-expandable stent. Lesions included total occlusion (28%), dissection (42%), post-PTA restenosis (21%), and unsatisfactory PTA (9%). Complications included one aortic protrusion, one acute thrombosis of the stent (resolved with urokinase), and three distal embolizations (5.7%) (resolved with urokinase and aspiration). During 15 months of follow-up, two patients died (one after occlusion). Three other occlusions occurred; one of these was resolved with local thrombolysis. Hyperplasia occurred in seven cases (13.5%), and stenosis occurred at the end of the stent because of incomplete covering of the lesion in three (5.8%); a complementary procedure was performed in six of these cases. Primary patency was 85.3% at 12 months and 80.9% at 18 months; secondary patency rate was 96.1% at 12 and at 18 months. At the end of the study, excluding data for the two patients who died, 27 limbs (54%) were asymptomatic and improvement was achieved in 19 (38%); the clinical success rate was 92%. No amputations were required.
Abdominal abscess due to Cardiobacterium hominis and Clostridium bifermentans. A case of abdominal abscess and bacteremia due to Cardiobacterium hominis and Clostridium bifermentans was successfully treated with surgical drainage and ampicillin-penicillin. This case represents the rare occurrence of C. hominis infection without apparent endocarditis.
Testicular torsion: a surgical emergency. Testicular torsion is caused by twisting of the spermatic cord, which results in compromised testicular blood flow. The degree of ischemic injury is determined by the severity of arterial compression and the interval between the onset of symptoms and surgical intervention. Torsion usually occurs at puberty, and an anatomic defect known as "bell-clapper" deformity is usually present. Typical symptoms include acute scrotal pain with associated nausea and vomiting. Up to one-half of patients report previous similar episodes. On examination, the testis is high-riding, tender, swollen and firm. Testicular scan or Doppler ultrasound examination can be helpful in distinguishing torsion from acute epididymitis. Prompt surgical treatment is indicated to reduce the torsion, and bilateral orchiopexy is performed to prevent recurrence. Exocrine function, as determined by semen analysis, is often abnormal after unilateral torsion.
Right-sided aortic arch presenting as refractory intraoperative and postoperative wheezing. A 29-year-old woman presented with severe refractory intraoperative wheezing and airflow limitation that resolved spontaneously. Contrast-enhanced computed tomographic (CT) scan of the thorax confirmed a right-sided aortic arch. Variable intrathoracic large airway obstruction that worsened markedly when the patient was in a supine position and slightly more following intravascular volume expansion was shown on flow-volume studies. We postulate the right-sided aortic arch caused airflow obstruction that worsened intraoperatively because of position and intravenous fluids.
First place--Resident Clinical Science Award 1990. Suppression of lymphokine-activated killer cell cytotoxicity by a soluble factor produced by squamous tumors of the head and neck. Incubation of human peripheral blood lymphocytes (PBL) in the presence of interleukin-2 results in the generation of lymphokine-activated killer (LAK) cells that are highly cytotoxic to a variety of autologous and allogenic tumor targets. We have identified a noncytotoxic, soluble factor, produced by human squamous cell cancers of the head and neck, that profoundly inhibits the generation of LAK cytotoxicity. Inhibition of the generation of cytotoxicity was demonstrated with coculture of PBL and freshly disaggregated tumor cells in a Transwell two-chamber system. Alternatively, inhibition occurred when LAK cells were generated in the presence of tumor-conditioned supernatants alone. These effects were not observed with conditioned supernatants from autologous or allogenic lymphocytes, human fibroblasts, or the erythroleukemia cell line K562. The presence of this inhibitory factor(s) was not required during the entire period of LAK generation. Suppression of cytotoxicity, measured after 4 days of LAK generation, could also be demonstrated when the conditioned tumor supernatant was present in only the last 24 hours of incubation. Suppression is mediated by a heat-labile factor with a molecular weight of greater than 75 kd. These results suggest that LAK cytotoxicity may be significantly impaired by soluble immunoregulatory factors present within the tumor milieu of squamous cell carcinomas of the head and neck. Further characterization of these factors may lead to the development of more rational and effective forms of immunotherapy.
Adenylate cyclase activity in various components of the sarcoplasmic reticulum: a cytochemical study of ventricular biopsies from diseased human hearts. Localization of adenylate cyclase (ACLase) activity was studied in biopsies of diseased human myocardium by means of electron microscopic cytochemistry. Five right and seven left ventricular biopsy specimens were obtained from patients with idiopathic dilated (3 cases) and hypertrophic (3 cases) cardiomyopathies, various acquired (3 cases) and congenital (1 case) heart diseases, and other heart diseases (2 cases). Catecholamine-stimulated ACLase activity was assessed relative to the fine structure of cardiocytes. The most intense ACLase activity was found in the sarcoplasmic reticulum (SR), but activity was also present in the sarcolemma. The enzyme activity was present in a wide morphologic spectrum of components of the SR, including junctional SR of internal and peripheral coupling (12 cases), free SR in association with myofibrils (6 cases), and free SR in association with mitochondria (5 cases). ACLase activity in junctional SR in the human myocardium resembles the findings in hearts of other mammalian species. The enzyme activity in human myocardial SR may represent a local regulatory function of the ACLase-cyclic AMP-phosphodiestrerase system in the SR components.
Effect of a taurine-supplemented diet on conjugated bile acids in biliary surgical patients. The effect of a taurine-supplemented diet on the level of conjugated bile acids in postoperative patients was investigated during two consecutive 5-day period. Eighteen hepatobiliary patients with choledochostomies and a specific T-tube insertion were collected and divided randomly into two groups. In group 1, an ordinary postoperative soft diet was prescribed for the first 5 postoperative days and then followed with a taurine-supplemented soft diet (40 mumol/kg per day) for 5 consecutive days. In group 2, the taurine-supplemented diet was prescribed in reverse. At the end of the two periods, on days 5 and 10, bile was collected via a T-tube with an inflatable balloon and low-pressure motor suction. Analysis of conjugated bile acids was done by high-performance liquid chromatography. The results showed that a taurine-supplemented diet increased the concentration of taurocholic acid, glycocholic acid, taurochenodeoxycholic acid, glycochenodeoxycholic acid, and total bile acid from 0.5, 1.9, 0.3, 1.4, and 4.7 mg/mL (on day 5) to 1.1, 3.5, 1.0, 2.6, and 8.9 mg/mL, respectively, on day 10 in group 1. Similar findings were noted in group 2. These results indicate that a taurine-supplemented diet may enhance the conjugation and secretion of bile acid in hepatobiliary patients.
Failure of right-sided coloanal anastomosis for treatment of left-sided ulcerative colitis. Report of a case. A patient with ulcerative colitis limited to the rectum and distal colon underwent a left hemicolectomy, a mucosal proctectomy, and a coloanal sleeve anastomosis using the normal proximal colon. She experienced macroscopic recurrence of her disease within 2 months of the operation and eventually required excision of the remaining colon and an end ileostomy. Our experience and that of others would indicate that a right-sided coloanal operation is unsuitable for the treatment of left-sided ulcerative colitis.
Activated T-cell subsets in benign lymphoid hyperplasias and B-cell non-Hodgkin's lymphomas. Activated tumor-infiltrating T lymphocytes (TIL-T) were quantitated prospectively in excisional biopsy specimens of 49 B-cell non-Hodgkin's lymphomas (NHL) of various grades and compared with eight benign lymphoid hyperplasias (BLH) to identify any potential difference in host T-cell response. Immunotyping of tissue-cell suspensions was done by three-color flow cytometry, which was complemented by immunocytology by using cytocentrifuged preparations. Two activated T-cell subsets were studied: acutely activated TIL-T (CD3+ CD25+ HLADr-) and chronically activated TIL-T (CD3+ CD25- HLADr+). Results showed an association of the more aggressive intermediate/high-grade B-cell NHL with a higher percentage of late-phase activated TIL-T and a progressive increase with the grade of malignancy: 10.29%, 23.25%, 33.87%, and 47.78% (means) for BLH and for low-, intermediate- and high-grade B-cell NHL, respectively. Differences for this subset were significant (P less than 0.050) for the following comparisons: hyperplasia versus intermediate-grade NHL (P less than 0.0012), hyperplasia versus high-grade NHL (P less than 0.0002), and low versus high-grade NHL (P less than 0.0080). The percentage of acutely activated TIL-T cells did not show a statistically significant difference between the groups. The results suggest a host T-cell response to proliferating neoplastic cells in B-cell NHL. Paradoxically, the response does not appear to be protective for the host since the intensity is directly proportional to the grade of malignancy. However, the recognition of this response may have clinical applications since its amplification with biological response modifiers may result in effective adoptive immunotherapy of B-cell NHL. Further clarification of the specificity and biologic significance of host T-cell activation in B-cell NHL will require functional studies of isolated lymphocytic subpopulations from neoplastic tissue.
Radionuclide angiographic evaluation of left ventricular diastolic function. Left ventricular diastolic function is altered in the majority of patients with cardiac diseases, especially those characterized by myocardial ischemia or hypertrophy. In many circumstances, such abnormalities related to impaired relaxation or reduced distensibility may precede evidence of left ventricular systolic dysfunction. Radionuclide angiography may be adapted to study the rapid filling phase of diastole, the duration of the isovolumic relaxation phase, the relative contributions of rapid filling and atrial systole to left ventricular stroke volume, and the relation between regional nonuniformity of left ventricular function and global filling properties. Technical aspects of data acquisition that must be considered for such studies include the effects of cardiac cycle length fluctuations, temporal resolution, temporal smoothing, and normalization parameters. As noninvasive radionuclide methods (and any other analyses using purely noninvasive techniques) do not permit assessment of the left atrial-left ventricular pressure gradient or the simultaneous evaluation of changes in left ventricular pressure and volume during relaxation and filling, complete clinical interpretation of "abnormal" left ventricular filling indexes, or changes in these indexes after interventions, is not possible. Despite the inherent limitations of noninvasive assessment of left ventricular diastolic function, radionuclide evaluation of left ventricular filling may provide clinically useful insights, especially in patients with congestive heart failure symptoms and normal left ventricular systolic function.
Pulse oximetry in acute asthma. The predictive value of pulse oximetry was evaluated in 100 patients who attended the emergency department with acute asthma. Oximetry after treatment with a cut off point of less than 91% had a sensitivity of 42% and specificity of 78% for unfavourable outcome, and oximetry before treatment had a sensitivity of 36% and a specificity of 57%. Despite its low sensitivity, oximetry after treatment does seem to have a role in minimising diagnostic errors in the emergency department, but only when used in conjunction with clinical assessment.
Carcinoma of the larynx. Changing incidence in women. Laryngeal carcinoma has classically been considered a disease of men with a history of tobacco and alcohol abuse. Substantial increases in the incidence of laryngeal carcinoma have occurred among both men and women from 1947 through 1984. In men, the incidence has increased from 5.6 to 9.0 per 100,000 population and in women, from 0.5 to 1.5 per 100,000 population. We recently encountered three consecutive cases of laryngeal carcinoma in women at the Ben Taub General Hospital, Houston, Tex, diagnosed and treated over a 3-month period. Each woman had a long history of cigarette smoking, and two also had a history of alcohol abuse. These consecutive presentations of laryngeal carcinomas in women prompted us to examine our Cancer Registry Files from 1959 through 1973 and 1974 through 1988. Over these two 15-year periods, the male-to-female ratio declined from 5.6:1 to 4.5:1, reflecting a greater incidence among women.
Interaction between dactinomycin and tumor necrosis factor in mesothelioma. Cachexia without oncolysis. There is no effective therapy for human malignant mesothelioma, and its susceptibility to recombinant cytokines has not been studied extensively. Recombinant human tumor necrosis factor alpha (rHuTNF alpha) was evaluated for its in vitro and in vivo antitumor activity using a human malignant mesothelioma cell line [DeH128(m)], both in culture and heterotransplanted in nude mice. In vitro, rHuTNF alone had no direct antimesothelioma activity assessed using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl-tetrazolium bromide assay, but in combination with the transcription inhibitor, dactinomycin (AD), mesothelioma cell metabolic activity was inhibited (80% of control). The effects of this combination of agents were studied on DeH128(m) cells heterotransplanted as subcutaneous tumors in nude mice. In vivo there was no significant inhibition of tumor growth by combined rHuTNF alpha and AD therapy, but the combination produced marked cachexia in doses at which each component (rHuTNF alone or AD alone) was well tolerated. The authors conclude that the well-described in vitro interaction between AD and rHuTNF also operates in vivo to produce cachexia and that the combination of these two agents is likely to have a low therapeutic index in malignant mesothelioma.
Induced bone development in transplants of fresh human pseudomalignant heterotopic ossification tissue in athymic nude mice. Biopsy specimens of mature trabecular bone from tumors of two typical cases of pseudomalignant heterotopic ossification (PHO; myositis ossificans circumscripta) were transplanted into athymic nude mice. Specimens of normal metaphyseal bone in adjacent areas were also transplanted in the contralateral hindquarter muscles for controls. By seven days, control bone transplants were necrotic and enveloped in granulation tissues whereas PHO transplants were surrounded by proliferating connective tissue derived from the host-bed muscle tissues. In the intervals from 14 and 21 days, the PHO transplants showed vascular and hypertrophied connective-tissue proliferation with appositional deposits of new bone. The microscopic features of the new bone suggested that it was of mouse host-bed origin because the new bone from Case 1, a female, showed nuclei without sex chromatin. The quantities of new bone were measured by correlated histomorphometric and computer image analysis of microradiographs. Little or no cartilage development was noted at any stage. The normal control trabecular bone tissue was slowly resorbed by macrophages and mononuclear phagocytes; multinucleated giant cells were few and relatively small. Except in one questionably small area of one transplant, nontumorous undemineralized normal human bone failed to induce bone formation within the 28-day period of observation. The quantity of new bone formed in athymic mice in response to implants of PHO, estimated from equivalent quantities of bone developed from implants of lyophilized matrix-free bone morphogenetic protein (BMP) was about 1 microgram/g of wet PHO tumor weight. Although circumstantial evidence implicates BMP in the pathogenesis of heterotopic ossification, more research should be directed toward regional and systemic factors inhibiting bone development in normal and abnormal conditions, including malignant bone tumors.
Nonrandom distribution of N-myc oncogene genotypes in neuroblastoma. The distributions of Pvu II and Sph I alleles of the N-myc oncogene (also known as MYCN) were studied in a series of normal individuals and pediatric patients with solid tumors. In the case of Pvu II, where the polymorphic site is located 3' of the gene, the frequencies of the allele were 0.27 (11-kilobase fragment) and 0.73 (8-kilobase fragment) in 43 unrelated normal Caucasians. The frequencies of the allele were similar in 40 non-N-myc-amplified neuroblastomas, 47 Wilms' tumors, and 31 other pediatric tumors. In these cases, the genotypes were in Hardy-Weinberg equilibrium. In 18 N-myc-amplified neuroblastomas, however, the observed genotype frequencies deviated from Hardy-Weinberg equilibrium (P less than .005). Similar observations were made with an Sph I restriction fragment length polymorphism where the polymorphic site is located in intron 2. The differences between amplified and nonamplified neuroblastomas suggest a possible involvement of sequences at or near N-myc in the progression of tumors where the N-myc gene is amplified.