shukoor65/lab-rag-model huggingface dataset:
Ganglioside GM3:GD3 ratio as an index for the management of melanoma. This report evaluates the relevance of the ratio of the melanoma-associated ganglioside, GD3, and its precursor, GM3, to prognosis and management of Stage II disease. Tumor biopsy specimens from 42 melanoma patients were examined for the ratio and found that GD3 and GM3 constitute 80% of the total lipid bound sialic acids (LBSA) of melanoma. Although the ratio of GM3:GD3 in melanocytes, the progenitors of melanoma, is 19:1 (based on %LBSA), it ranged from 15:1 to 1:5 in tumor biopsy specimens. Patients are categorized into three groups based on their GM3:GD3 ratio (%LBSA) of tumor tissues as Group I (ratio ranged from 15:1 to 1.5:1) (10 of 42), Group II (1.4:1 to 1:1.4) (13 of 42), and Group III (1:1.5 to 1:5) (19 of 42). When the overall survival of patients from the onset of Stage II disease was evaluated among different groups, patients belonging to Group I survived significantly longer than patients of Group II (P = 0.02) and Group III (P = 0.01). Interestingly, Group III expressed immunogenic gangliosides (GD2, GM2, and O-AcGD3) better than the other groups and may benefit more from therapies targeted against these gangliosides antigens. The results of this study indicate that GM3:GD3 ratio is an unusual but well-defined biochemical criteria that may be useful for prognosis and therapeutic management of the disease. Therefore, we propose a routine analysis of the GM3:GD3 ratio of tumors excised after surgery. Screening the ratio is feasible since melanoma expresses a simple profile of gangliosides unlike other forms of cancer.
Hemodynamic effects and tolerability of intravenous amiodarone in patients with impaired left ventricular function. Acute hemodynamic effects and tolerability of intravenous amiodarone, 5 mg/kg administered over 5 minutes, were compared in patients with coronary artery disease and either a normal (left ventricular [LV] ejection fraction greater than or equal to 45%, n = 10, group N) or impaired LV function (ejection fraction less than 45%, n = 9, group L). Amiodarone reduced systemic vascular resistence and LV and aortic pressures in both groups (13%, 18%, and 13%, respectively [group N], and 15%, 17%, and 15%, respectively [group L]) over the short term. Heart rate initially increased (18%, group L, and 10% group N), but was followed by a late 6% decrease in group N only, and by a progressive reduction in contractility (Vmax), together with a rise in LV end-diastolic pressure (19% and 38%, respectively [group N] and 17% and 58%, respectively [group L]; all values p less than 0.05 versus control). Coronary flow increased significantly by 20% (group N) and 31% (group L), but only during amiodarone administration, accompanied by a 26% and 25% reduction in myocardial oxygen extraction in groups N and L, respectively. Stroke work decreased in both groups (20% [group N] and 19% [group L], p less than 0.05 versus control). In contrast, cardiac output only improved (10%) in patients with impaired ventricular function. Significant side effects did not occur. Thus relatively high dosages of intravenous amiodarone are well tolerated and improve cardiac pump function in patients with an impaired, but not with a normal cardiac function. However, the tendency to increase LV end-diastolic pressures necessitates careful monitoring in patients in whom preexisting LV filling pressure may be elevated.
Bronchial carcinoid tumors: assessment with CT of location and intratumoral calcification in 31 patients. Bronchial carcinoid tumors (BCT) have long been regarded as predominantly central and rarely calcified. The authors retrospectively reviewed computed tomographic (CT) findings in 31 patients (thin-section CT studies in 18) who were seen at their institution with the histopathologic diagnosis of BCT (27 typical, four atypical) during the years 1978-1989. Eighteen BCT (58%) were central and 13 (42%) peripheral, with peripheral defined as located more than 2 cm distal to the origin of the appropriate segmental bronchus. CT scans revealed varied patterns of calcification in seven (39%) of the 18 central BCT and in one (8%) of the 13 peripheral BCT (P less than .1); overall, CT scans revealed calcification in eight (26%) of the BCT. The eight calcified tumors were each of the typical histopathologic type. Peripheral BCT (42%) were nearly as common as central BCT (58%), and CT detection of calcification in BCT was not uncommon (39% of central lesions; 26%, overall).
Rickettsial infection of the central nervous system: the role of prompt antimicrobial therapy. Rickettsial diseases of man, which are prevalent in all the continents (except Antartica) continue to be a major health problem in tropical and temperate parts of the world. Rickettsioses must be considered in every traveller seeking medical attention soon after returning from endemic areas, since the disease can be associated with significant morbidity. When a definite diagnosis has been made by specific serological tests, prompt antimicrobial therapy is indicated. A tetracycline should be regarded as the drug of choice due to its high efficacy, low toxicity, superior in vitro activity and the possibility of relapse which can follow chloramphenicol therapy.
Changes in splenic microcirculatory pathways in chronic idiopathic thrombocytopenic purpura. The spleen plays a central role in the pathogenesis of chronic idiopathic thrombocytopenic purpura (ITP); it produces massive quantities of antiplatelet antibodies, leading to accelerated phagocytosis of platelets. Lymphoid hyperplasia typically occurs in the spleen, characterized by large numbers of lymphatic nodules with active germinal centers. Whether changes in splenic microcirculatory pathways also occur is not known. We have studied this question by scanning electron microscopy of corrosion casts, comparing spleens removed from patients with ITP with normal spleens obtained from organ transplant donors. The casts demonstrate two major changes in microcirculatory pathways in ITP. Firstly, a striking proliferation of arterioles and capillaries is found in the white pulp and marginal zone (MZ), seen as extensive vascularization in 92.3% of lymphatic nodules (n = 191) versus 0.6% (n = 224) in normal spleens. Secondly, the marginal sinus, a series of flattened, anastomosing vascular spaces between the white pulp and MZ, is absent in 89.4% of lymphatic nodules versus 4.9% in normal spleens. The cause of these microcirculatory changes, which may not be exclusive to ITP, is presently unknown. Absence of the marginal sinus may affect distribution of blood flow through the MZ such that platelets spend increased amounts of time in the proximity of macrophages. In the presence of antiplatelet antibodies found in ITP spleens, this delayed transit would lead to greatly increased platelet destruction.
Thin-layer chromatography to monitor cholesterol gallstone dissolution by methyl tert-butyl ether. We describe a simple and inexpensive method of monitoring methyl tert-butyl ether (MTBE) dissolution of cholesterol gallstones with thin-layer chromatography (TLC) in 10 patients. TLC is a routine semiquantitative laboratory method that can be used to measure the cholesterol concentration present in the MTBE and bile mixture aspirated through the cholecystostomy catheter during gallstone dissolution. TLC is practical in the clinical setting because it can be used to determine if gallstone dissolution is occurring and when MTBE lavage is no longer effective. TLC is performed in the laboratory with routine material and is completed in 15 min. Each TLC measurement costs about $1. The procedure provides objective and specific chemical information on effectiveness and progression of gallstone dissolution, apart from the radiologic and sonographic studies. In our study, TLC signaled effective dissolution in the initial phase of gallstone dissolution by detecting large amounts of cholesterol in the MTBE and bile mixture even before a visible change in size or shape of the stone became apparent by transcatheter cholecystography or by sonography (six of 10 patients). Conversely, lack of cholesterol on TLC after 1 hr or more of MTBE infusion indicates that the stones are pigmented or contain substantial calcium. This means that dissolution with MTBE will be ineffective and that solvent infusion should be terminated. In those cases in which dissolution is progressing well, when TLC shows decreasing amounts of cholesterol in the effluent, only residual fragments insoluble to MTBE remain or the stone is sequestered from MTBE; at this point, solvent infusion should be discontinued or the catheter must be repositioned. Monitoring the rate of cholesterol dissolution by TLC provides important complementary information to cholecystography and sonography during gallstone treatment with MTBE.
A comparison of two-point discrimination threshold of tactual, non-painful stimuli between chronic low back pain patients and controls. Differences in pain sensitivity between chronic pain patients and healthy controls have been reported. Seltzer and Seltzer extended this line of research in studying the sensitivity to non-painful stimuli. They reported that the 2-point discrimination threshold of chronic pain patients was higher than that of control subjects. However, the study of Seltzer and Seltzer suffered from several methodological shortcomings. Therefore, in the present study we tried to replicate the findings in a group of chronic low back pain patients using a design that was believed to be methodologically stronger. Replication failed: no evidence was found for the hypothesis that chronic pain patients are less sensitive to non-painful stimuli. Further studies on various defined types of acute and chronic pain patients are required.
Hypertension in women: what is really known? The Women's Caucus, Working Group on Women's Health of the Society of General Internal Medicine. PURPOSE: To determine whether there is sufficient information in the medical literature to guide appropriate treatment of hypertensive women. DATA IDENTIFICATION: Epidemiologic surveys of hypertension, clinical trials of antihypertensive therapy, and studies of selected adverse effects of antihypertensive agents were identified through a computerized search using MEDLINE and by identifying all studies cited in current medical textbooks as supporting evidence for the guidelines for the treatment of hypertensive individuals. All epidemiologic studies selected were cross-sectional or longitudinal, multicenter, population-based surveys. All clinical trials were large, randomized studies comparing one or more antihypertensive agents with a placebo or nonplacebo control group. Epidemiologic studies and clinical trials were reviewed to assess the quantity and quality of information available regarding important aspects of hypertension in women. Data pertaining to epidemiology, natural history, results of treatment, and two significant side effects of antihypertensive treatment were examined. RESULTS OF DATA ANALYSIS: The prevalence of hypertension is greater in black women than in black men and is about equal in white women and men. Because women outnumber men in the population, there are more hypertensive women than men. The attributable risk percent (the proportion of end points that could be eliminated by removing hypertension) for cardiovascular complications of hypertension is higher for women than men. Clinical trials show clear benefit of therapy for black women but no clear benefit for white women; some studies suggest that treatment of white women is harmful. Lipid profiles and their relation to ischemic heart disease differ for women and men; there is currently no information on the effects of antihypertensive agents on serum lipids in women. Few data have been published on the frequency of sexual dysfunction in treated hypertensive women. CONCLUSIONS: Hypertension in women and its related cardiovascular outcomes are a major public health problem. Clinical trials of antihypertensive therapy do not fully support current guidelines for the treatment of hypertensive women. Research concerning adverse effects of antihypertensive agents has largely excluded women from consideration; further studies are required to guide appropriate treatment.
The role of endogenous gonadotropin release in the etiology of ovarian enlargement during purified urinary follicle-stimulating hormone therapy. Patients with polycystic ovarian disease were grouped into three groups according to their maximum ovarian diameter (maxD) after ovulation induction by purified urinary follicle-stimulating hormone (FSH). Serum luteinizing hormone (LH) and FSH were measured daily by radioimmunoassay and size and number of follicles were assessed by ultrasonography. Follicle-stimulating hormone in group A (80 mm less than or equal to maxD) was significantly higher than those of group B (60 mm less than or equal to maxD less than 80 mm) and C (maxD less than 60 mm) for the last 4 days of the treatment. This FSH rise in group A was not accounted for by FSH accumulation by the study of pharmacodynamics, and so was thought to be of endogenous origin. Luteinizing hormone was also elevated 3 days before the administration of human chorionic gonadotropin (hCG) in both groups A and B. The number of follicles in group A at hCG administration was significantly greater than that of group C. Any significant differences were not found in either total amount of purified urinary FSH or in the basal FSH and the LH levels before treatment of the three groups. These results suggest that excessive ovarian enlargement during gonadotropin therapy is caused by multiple follicular development primarily stimulated by endogenous FSH. Endogenous LH release further enhances ovarian enlargement.
Vascularized omentum graft for the reconstruction of the skull base after removal of a nasoethmoidal tumor with intracranial extension: case report. A 16-year-old boy with rhabdomyosarcoma occupying the nasal cavities and the ethmoid sinus with intracranial extension underwent transcranial surgery. The intradural tumor was resected first with the affected dura of the anterior skull base, and the dural defect was repaired with fascia harvested from the sheath of the rectus abdominis muscle. The remaining tumor contiguous to the nasal cavities was completely extirpated. The cranial cavity was then exposed to the opened nasal cavities, where a revascularized omental graft was used to separate these compartments. Lyophilized dura was placed beforehand beneath the omental graft, as a roof to the nasal cavity, and was removed 3 weeks later through the nostril. A bony skull base repair was performed over the omentum using the inner table of the bone flap. Subcutaneous fat from the abdomen was placed on the bone graft for fixation and as an additional seal for the dural defect. Reconstruction of the anterior skull base with a vascularized omental transfer provides an efficient barrier to the nasal cavity. It also serves as an excellent supporting structure for regeneration of the mucosal epithelium of the nasal cavities.
Beta-blocker treatment of dilated cardiomyopathy. Beneficial effect of carteolol in mice. BACKGROUND. The effects of carteolol, a nonselective beta-adrenergic receptor blocker with intrinsic sympathomimetic activity, were compared with those of metoprolol in a murine model of viral myocarditis and dilated cardiomyopathy caused by encephalomyocarditis virus. METHODS AND RESULTS. In the acute experiment, BALB/c and DBA/2 mice were inoculated with encephalomyocarditis virus. BALB/c mice were then given carteolol at 1 (n = 10), 10 (n = 10), 30 (n = 11), or 100 mg/kg (n = 9) daily, and DBA/2 mice were given carteolol at 1 (n = 9) or 10 mg/kg (n = 9) daily starting the day of inoculation. Controls were given distilled water (n = 23 for BALB/c mice and n = 8 for DBA/2 mice). BALB/c mice were killed on day 7, and DBA/2 mice were killed on day 14. In the subacute experiment, DBA/2 mice were inoculated with the virus and then given carteolol at 1 (n = 12) or 10 mg/kg (n = 16), or distilled water (n = 27) daily, starting on day 14. Mice were killed on day 28. Virus replication, murine survival, heart weight to body weight ratio, and histopathological findings were similar in each group in the acute and subacute experiments. In the chronic experiment, DBA/2 mice were inoculated with the virus and were then given carteolol at 1 (n = 13) or 10 mg/kg (n = 9), metoprolol at 30 mg/kg (n = 9), or distilled water (n = 31) daily, starting on day 14. Mice were killed on day 104. Heart weight to body weight ratio and histopathological scores were significantly lower in mice given carteolol than in the infected control group. Furthermore, left ventricular cavity dimension, left ventricular wall thickness, and myocardial fiber diameter of the left ventricle were significantly reduced in mice given carteolol compared with the control group. Metoprolol did not cause any significant changes compared with the control group. CONCLUSIONS. This study suggests that carteolol prevents the development of myocardial lesions similar to those in dilated cardiomyopathy after myocarditis in the chronic stage.
Long-term results of simple and radical nephrectomy for renal cell carcinoma. From 1974 to 1983, simple and radical nephrectomies were performed at the Chaim Sheba Medical Center (Tel Hashomer, Israel) for renal cell carcinoma. The authors reviewed 109 cases that were followed for a period ranging from 5 to 14 years. Simple nephrectomy was performed in 55 patients, and 54 patients underwent radical nephrectomy. The selection of the surgical procedure was based on the surgeon's preference and not on the basis of clinical stage, age, or sex. The surgical results and survival rates were assessed according to the pathologic stage of the tumors. Among patients with Stage I tumor, radical nephrectomy produced better survival rates at 5 and 10 years (P = 0.03); however, when the non-cancer deaths were excluded, the difference in survival was not statistically significant. For Stage I tumors the survival free of disease at 5 years was better for the radical nephrectomy group, but this difference was not statistically significant. No difference was noticed in the local recurrence rate between the two groups. Nephrectomy in patients with Stage IV disease did not alter survival regardless of the type of operation.
Urinary tract malformations in identical twins. We describe 3 sets of twins with discordance for urological malformations. Zygosity was documented by HLA and blood group typing. It is suggested that evaluation of the identical twin of an affected patient should include the entire urinary tract because of the potential for different lesions.
Late onset endophthalmitis associated with intraocular lens: a case of molecularly proved S. epidermidis aetiology. A case of severe endophthalmitis after cataract extraction followed by posterior chamber lens implantation is reported. Microbiological cultures from a tap of the patient's aqueous humour prior to lens explantation as well as from the explanted lens and aqueous and vitreous humour during operation yielded Staphylococcus epidermidis sensu stricto. Scanning electron microscopy showed massive colonisation of the lens loop by staphylococci. Clonal identity of all isolates was demonstrated by plasmid DNA analysis and sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) of extra-cellular products. This is strongly suggestive of the aetiological role of S. epidermidis in this case of late onset endophthalmitis.
Fatigue fracture of the ulna occurring in pitchers of fast-pitch softball. We have reported three cases of fatigue fracture of the ulna in male pitchers of fast-pitch softball. To elucidate the etiology of injury, we first selected three healthy male and three healthy female pitchers from a well-trained college team and analyzed their forearm movement by high-speed cinematography. This showed slight flexion of the elbow joints during wind-up motion, dorsal flexion of the hand joints upon releasing the ball, and extreme pronation of the forearms during the follow-through. We then took 8 mm CT scanning sections of the forearms. Using these images, we investigated shapes and areas of cross-sections of the ulna and its cortical and cancellous bones from the elbow to the hand joints. Our results reveal that the shapes of the sections are significantly different from circles at around the center of the ulna, and the cross-sectional areas are smaller in the middle one-third of the ulna than in other parts. These observations imply that fatigue fractures of the ulna in pitchers of fast-pitch softball must be torsionally induced, tending to occur at the middle one-third of the bone.
Stress hormones and acid-base status of human fetuses at delivery. The relationship of plasma concentrations of arginine vasopressin (AVP), ACTH, cortisol, and PRL in the human fetus to mode of delivery and acid-base status has been investigated in 91 term pregnancies consisting of 4 groups based on mode of delivery, type of anesthesia, and use of ephedrine prophylaxis for maternal blood pressure control. Infants delivered vaginally after uncomplicated labors had higher umbilical cord plasma concentrations of AVP, ACTH, and cortisol than infants delivered without labor. Use of ephedrine, an alpha-agonist, during regional anesthesia was associated with elevated plasma AVP and ACTH concentrations compared to those in women receiving general anesthesia. At the time of delivery, 12 infants had acidemia (pH less than 7.20), as judged by pH of umbilical arterial blood. Their plasma AVP, ACTH, and cortisol levels did not differ from those of infants delivered by uncomplicated vaginal delivery, but were greater than those of infants delivered by cesarean section under general anesthesia. Moreover, in infants with acidemia, plasma concentrations of AVP and ACTH were significantly correlated, but PRL levels were unaffected by mode of delivery or acidemia. Elevated umbilical cord plasma concentrations of AVP, ACTH, and cortisol characterize term vaginal deliveries and are associated with intrauterine stress, demonstrating activation of the fetal hypothalamic-pituitary-adrenal axis and suggesting that AVP is important in ACTH release in the human fetus; however, PRL does not appear to be an important stress hormone.
A case of adult T cell leukemia complicated by proliferative synovitis. A 60-year-old woman was admitted to our hospital with symmetrical arthritis of the knees. During the 2 years preceding admission, she had experienced recurrent arthritis. A histological examination of her synovial tissue showed prominent villous proliferation of the synovial cells, prominent vascularity throughout and an inflammatory infiltrate composed of abnormal mononuclear cells. Three months later, she developed fever, skin eruptions, lymphadenopathy and hepatosplenomegaly. She also had hypercalcemia and there was abnormal lymphocytosis in her blood smears. She was diagnosed as having adult T cell leukemia. Parenteral chemotherapy treatment with adriamycin and cyclophosphamide gave remission of all the manifestations of disease, including arthritis. Her leukemia recurred, however, and she died 6 months after the diagnosis was made.