shukoor65/lab-rag-model huggingface dataset:
Radiographically occult endobronchial obstruction in bronchogenic carcinoma. PURPOSE: While central endobronchial tumors may become radiographically detectable when they cause significant endobronchial obstruction, the incidence of radiographically undetectable obstruction is not known. This study prospectively examined the incidence of radiographically undetectable completely obstructing lesions encountered during routine diagnostic bronchoscopy. PATIENTS AND METHODS: Patients referred for bronchoscopy at the San Diego Veterans Administration Medical Center because of suspected bronchogenic carcinoma formed the population base. Chest radiographs were interpreted routinely 24 hours prior to bronchoscopy. Patients found to have complete endobronchial obstruction during bronchoscopy were included in the analysis. RESULTS: Eighty-one completely obstructing lesions were found in 77 patients. No radiographic signs of obstruction were found in 36 (44%) completely obstructing endobronchial lesions. There was no difference in the rate of radiographically occult tumors based on cell type. Obstruction of segmental bronchi was more likely to be undetectable than obstruction of more proximal airways. Chest radiographs were normal in 13 (16%). All 13 had risk factors for and symptoms suggestive of bronchogenic carcinoma. CONCLUSION: Complete endobronchial obstruction due to bronchogenic carcinoma can occur frequently in patients at risk for lung cancer. The significant incidence of radiographically undetectable complete obstruction has implications for the diagnosis, staging, and assessment of treatment of lung cancer.
Curative potential of primary whole-abdomen irradiation in ovarian carcinoma. Ovarian carcinoma remains a leading cause of cancer mortality in American women. The identification of active chemotherapy drugs and regimens has resulted in much less frequent use of radiation therapy at a time when technical and conceptual advances have been made. Unfortunately, the shift from radiotherapy to chemotherapy has not produced a discernible improvement in patient survival. Retrospective and prospective data suggest that whole-abdomen irradiation offers curative potential in patients with nonbulky residual disease after surgical cytoreduction. Its use should therefore be reconsidered as a primary adjuvant therapy in properly selected patients.
Differences in release of tumor necrosis factor from THP-1 cells stimulated by filtrates of antibiotic-killed Escherichia coli. Bacterial products, such as endotoxin, activate mononuclear cells to produce tumor necrosis factor (TNF) and other monokines capable of producing host cell injury. THP-1 cell TNF release in response to bacterial products generated during antibiotic killing of Escherichia coli (ATCC 12014) was evaluated. THP-1 is a mature monocytic leukemia cell line that produces TNF in a dose-dependent fashion in response to purified endotoxin. E. coli were incubated in the presence of amikacin, ciprofloxacin, ceftazidime, cefotaxime, aztreonam, or imipenem at concentrations that killed greater than 99.9% of the organisms. Aliquots of these antibiotic-bacterial cultures were added to THP-1 cells, and TNF concentrations were determined by specific immunoassay. Amikacin and imipenem produced rapid bacterial killing and were associated with low TNF levels. Ceftazidime, aztreonam, and cefotaxime killed E. coli at a slower rate and were associated with significant increases in mononuclear cell TNF responses. Ciprofloxacin produced intermediate TNF levels. Differences exist among bactericidal antibodies in their ability to generate products capable of stimulating mononuclear cell TNF release.
Cyclic AMP mediates the direct antiproliferative action of mismatched double-stranded RNA. Previous experiments have demonstrated that double-stranded RNAs (dsRNAs) can exert an antiproliferative effect on human tumor cells, independent of interferon (IFN) induction. However, the mechanism by which dsRNAs inhibit tumor growth has not been elucidated. As a first step in determining the molecular events responsible for growth arrest, we have explored the role of signal transduction through the cAMP system in the antiproliferative effect of the mismatched dsRNA, r(I)n.r(C12,U)n (Ampligen). These studies utilized the human glioma cell line A1235, which does not produce detectable levels of IFN-alpha, -beta, or -gamma in response to mismatched dsRNA treatment. Treatment of A1235 cells with mismatched dsRNA in combination with either 1-(5-isoquinolinesulfonyl)-2-methylpiperazine (H-7), which inhibits cAMP-dependent protein kinase and protein kinase C, or N-(2-guanidinoethyl)-5-isoquinolinesulfonamide (HA1004), which preferentially inhibits the cAMP-dependent protein kinase, yielded an antagonism of the mismatched dsRNA-induced antiproliferative effect. Measurement of adenylate cyclase activation showed a dose-dependent increase in activity at antiproliferative mismatched dsRNA concentrations, but not at lower, nonantiproliferative doses. This increase in activity was rapid, seen as early as 30 sec after initiation of treatment, and it was sustained at peak levels for 1-2 hr. Analysis of the intracellular cAMP concentration gave similar kinetics of induction. Exposure of cells to the stable cAMP analogue dibutyryl cAMP yielded dose-dependent inhibition of cell growth. The cAMP phosphodiesterase inhibitor 3-isobutyl-1-methylxanthine also inhibited proliferation. In contrast, neither H-7 nor HA1004 had an effect on growth inhibition induced by human natural IFN-alpha treatment. In addition, antiproliferative doses of IFN-alpha did not increase cAMP concentrations. These results indicate that the cAMP system is utilized by mismatched dsRNA as an early signal transduction mechanism for growth control. Furthermore, the antiproliferative effects induced by mismatched dsRNA and IFN can occur by different mechanisms of action.
Parental origin of the extra chromosome in trisomy 18. The parental origin of the supernumerary chromosome 18 was investigated by RFLP analysis in 23 individuals with Edwards syndrome. All families were studied with the DNA probe pERT-25, which recognizes a locus of highly polymorphic tandemly repeated DNA sequences on chromosome 18. The extra chromosome was found to be of maternal origin in 19 patients (95%), of paternal origin in one patient (5%), and indeterminate in three patients. In one of the three indeterminate cases, a mosaic, an apparent recombination event had taken place within the pERT-25 locus. The overall high degree of informativeness of pERT-25 illustrates the power of a chromosome-specific variable-number tandem repeat probe (VNTR) in parental origin studies of aneuploidy.
Metabolic disturbance as a cause of recurrent hematuria in children. Metabolic disturbance as a cause of recurrent hematuria in children. To evaluate metabolic disturbance as a cause of hematuria, 250 children, aged eight months to fourteen years, with recurrent hematuria were studied. In the present series, metabolic disturbance was mainly due to idiopathic hypercalciuria (IH), the most common etiology of hematuria without proteinuria in childhood. Sixty-seven (27%) of the children had IH, ten children (4%) had hyperuricosuria, and 27 (11%) had nephrolithiasis. To better characterize the IH into renal (RH) or absorptive hypercalciuria (AH) subtypes, 45 of the 67 children (ranging age from six to twelve years) were further submitted to an oral calcium load test. Eighteen patients (40%) had AH, 7 (15.5%) RH and 20 (44.4%) could not be classified as having AH or RH [indeterminant (ID) idiopathic hypercalciuria group]. Intravenous pyelography or ultrasound were normal in all children. The oral calcium load test may be useful in characterizing the subtype of IH in some children; however, a great number of the IH children were characterized as indeterminant. Also hyperuricosuria, recently described as another metabolic disturbance associated with hematuria, may be an important cause of recurrent hematuria in children.
Prostate specific antigen values after radical retropubic prostatectomy for adenocarcinoma of the prostate: impact of adjuvant treatment (hormonal and radiation). Prostate specific antigen (PSA) levels were obtained before and after radical retropubic prostatectomy in 192 patients: 78 (41%) had pathological stage B2 cancer or less, 83 (43%) had stage C or C+ and 31 (16%) had stage D1 disease. Of those with stages B2 or less, C, C+ and D1 disease 82, 86, 65 and 90%, respectively, had postoperative PSA values of 0.2 ng./ml. or less (when first evaluated 30 or more days postoperatively). At 1 year postoperatively 94% of the stages C and C+ cancer patients treated with adjuvant radiation had PSA levels of 0.2 ng./ml. or less, which was significantly different from those not treated adjuvantly (p = 0.02). This effect of adjuvant radiation on PSA was temporary in the small number of patients with longer followup. Adjuvant orchiectomy for stage D1 lesions resulted in female PSA levels in virtually all cases. This decrease may be misleading and may reflect a direct hormonal effect rather than a decrease in tumor volume. Positive surgical margins did not significantly affect postoperative PSA levels, possibly because of the frequent use of adjuvant treatment.
Plasma prostanoids in neonatal extracorporeal membrane oxygenation. Influence of meconium aspiration. Thromboxane B2 may be a mediator of neonatal persistent pulmonary hypertension. Elevated levels of plasma thromboxane and prostacyclin have been described previously in hypoxic newborn infants with neonatal pulmonary hypertension. We measured serial plasma levels of thromboxane B2 and 6-keto-prostaglandin F1 alpha (stable metabolite of prostacyclin) in 21 newborn infants with severe respiratory failure and pulmonary hypertension who required extracorporeal membrane oxygenation support. We sought to study (1) the evolution of plasma prostanoids in pulmonary hypertensive infants treated with extracorporeal membrane oxygenation and (2) whether different pulmonary hypertensive diagnostic subgroups have distinctive prostanoid profiles. Our data indicated that infants with meconium aspiration had significantly lower levels of plasma thromboxane B2 and 6-keto-prostaglandin F1 alpha while receiving extracorporeal membrane oxygenation than did infants with persistent pulmonary hypertension but no meconium aspiration. Levels of all infants decreased progressively as extracorporeal membrane oxygenation support continued.
Left ventricular diastolic filling abnormalities identified by Doppler echocardiography in asymptomatic patients with sickle cell anemia. To determine whether left ventricular diastolic abnormalities are an early feature of sickle cell anemia, indexes of diastolic filling were obtained with pulsed Doppler echocardiography in 30 consecutive patients with this disease (mean age 29 years; range 19 to 39) who had not experienced symptoms of heart failure and had normal left ventricular systolic function. Data were compared with those in 30 normal control subjects of similar ages. Seventeen (57%) of the 30 patients with sickle cell anemia had evidence of abnormal left ventricular diastolic filling. Six of these 17 patients had a Doppler pattern consistent with "restrictive" filling, characterized by reduced early diastolic deceleration time (less than 110 ms) or an increased rate of decline of early flow velocity (EF slope greater than 7.4 m/s2), or both, as well as decreased late diastolic velocity-time integral (2.6 +/- 0.7 vs. 3.4 +/- 0.8 cm in normal subjects; p less than 0.05). Another 11 patients showed a Doppler waveform consistent with impaired relaxation, characterized by prolonged deceleration time (greater than 166 ms) or reduced EF slope (less than 3.8 m/s2), as well as increased late diastolic velocity-time integral (4.0 +/- 0.5 vs. 3.4 +/- 0.8 cm in normal subjects; p = 0.03). This Doppler echocardiographic analysis demonstrates that left ventricular diastolic filling patterns are altered in patients with sickle cell anemia and that these diastolic abnormalities may be present in the absence of symptoms of heart failure. These abnormal patterns suggest an intrinsic myocardial abnormality in patients with sickle anemia and may prove to be early markers of cardiac disease.
The effect of elemental diet on intestinal permeability and inflammation in Crohn's disease. This study examines whether treatment of acute Crohn's disease with an elemental diet improves intestinal integrity and inflammation as assessed by a 51Cr-labeled ethylenediaminetetraacetatic acid (EDTA) permeability test and the fecal excretion of 111In-labeled autologous leukocytes, respectively. Thirty-four patients with active Crohn's disease completed a 4-week treatment course with an elemental diet. Active disease was characterized by increased intestinal permeability [24-hour urine excretion of orally administered 51Cr-EDTA, 6.4% +/- 0.6% (mean +/- SE); normal, less than 3.0%] and by high fecal excretion of 111In-labeled leukocytes (14.2% +/- 1.1%; normal, less than 1.0%). Twenty-seven (80%) went into clinical remission, usually within a week of starting treatment. After 4 weeks of treatment, there was a significant decrease in both the urine excretion of 51Cr-EDTA (to 3.4% +/- 0.5%; P less than 0.01) and the fecal excretion of 111In (to 5.7% +/- 1.0%; P less than 0.001), indicating that such treatment is not just symptomatic. A framework for the mechanism by which elemental diet works, centering around the importance of the integrity of the intestinal barrier function, is proposed, and also appears to provide a logical explanation for some relapses of the disease.
Lymphocytic adenohypophysitis: an immunohistochemical study. Lymphocytic adenohypophysitis is a rare inflammatory disorder of the anterior pituitary gland. In some cases, there is evidence of concurrent autoimmune disease. We present the case of a 39-year-old woman who developed visual disturbance during the early postpartum period. Magnetic resonance imaging revealed an intrasellar mass with suprasellar extension. Study of the tumor tissue showed diffuse infiltration of the entire pituitary gland by lymphocytes and plasma cells. Immunohistochemical examination revealed that the majority of the infiltrating lymphocytes were T cells that might have modulated the immunoreaction to the anterior pituitary gland. We suggest that the disorder is related to cell-mediated immunity as well as humoral immunity.
Alcoholic cirrhosis and osteoporosis in men: a light and scanning electron microscopy study. Subjects with chronic alcoholism are associated with a higher prevalence of bone fractures, compared with age-matched controls. However, the pathogenesis of alcoholic osteopathy remains poorly understood. In this study, the bone cells activities and the bone matrix were studied using different techniques such as bone morphometry, scanning electron microscopy and computer reconstruction. Male patients (N = 20), aged 59.1 +/- 10.1 years, presenting a chronic decompensated alcoholic cirrhosis, were admitted into this study. A histomorphometric analysis of a transiliac bone biopsy was done after a double tetracycline labeling of the bone. A scanning electron microscopy (SEM) study was performed on eight out of the 20 patients on an additional biopsy. The bone mass was significantly decreased in cirrhotic patients. A marked defect in the osteoblastic function was observed with reduced osteoid parameters, lower mean wall thickness, and slower bone formation rate leading to a thinning of bone trabeculae. Conversely, trabecular resorption surfaces were markedly increased. SEM examination of bone biopsies was also consistent with delayed and impaired osteoblastic activity leading to extended and scalloped resorption surfaces covered by unusually thin layers of calcified collagen fibers. The reduced osteoblastic activity associated with normal osteoclastic function appears to play a major role in the pathogenesis of alcoholic osteoporosis leading to decreased bone mass with thinner trabeculae.
The role of echocardiography in the evaluation of mechanical complications of acute myocardial infarction. With the introduction of the coronary care unit and more effective therapy for primary life-threatening arrhythmias, cardiogenic shock and the mechanical complications of acute myocardial infarction are now responsible for the majority of in-hospital deaths. These mechanical complications, which include myocardial rupture of the left ventricular free wall, rupture of the ventricular septum, and rupture of the papillary muscle, are estimated to account for 25,000 fatalities yearly in the United States. Although the mechanism of myocardial rupture has not been clearly defined, there is increasing evidence that infarct expansion, which can be readily detected by two-dimensional echocardiography, may be an important pathophysiologic factor. The ready availability of echocardiography in the coronary care unit has made a major impact on the immediate diagnosis of mechanical complications in the hemodynamically compromised patient with acute myocardial infarction. In particular, two-dimensional and Doppler echocardiographic techniques have been extremely useful in the identification and localization of ventricular septal rupture. In addition, papillary muscle rupture can be readily diagnosed by Doppler approaches and is easily distinguished from ventricular septal rupture. In view of increasing evidence that early surgical intervention is indicated in these patients, these echocardiographic approaches offer the surgeon prompt diagnostic and anatomic information. Unfortunately, rupture of the free wall of the left ventricle often results in sudden death within minutes before echocardiographic evaluation can be attempted. Nevertheless, rapid echocardiographic diagnosis provides the patient with the possibility of potential life-saving resuscitative interventions before immediate surgery. Thus, over the past decade, echocardiography has become a vital tool in the diagnosis and evaluation of patients with mechanical complications of acute myocardial infarction. The development of Doppler techniques, color flow Doppler, and esophageal approaches should further enhance our diagnostic abilities and allow careful monitoring of patients before, during, and after surgical repair. It is hoped that with the improvements in echocardiographic evaluation of mechanical rupture and more rapid surgical intervention, future studies will demonstrate better surgical results with good long-term survival in patients with myocardial rupture.
Treatment of Parkinson's disease with proglumide, a CCK antagonist. Proglumide, a cholecystokinin antagonist, did not improve Parkinson's disease in a preliminary drug treatment trial.
Leukoaraiosis correlates with cerebral hypoperfusion in vascular dementia. Leukoaraiosis quantified by computerized densitometric measurements of reduced Hounsfield numbers was correlated with local cerebral blood flow on the same computed tomographic images of 35 patients with multi-infarct dementia and 16 age-matched elderly normal volunteers. The ratio for area of frontal leukoaraiosis to total area of parenchyma among the patients was significantly greater than that among the normal volunteers (5.8 +/- 2.3% compared with 3.1 +/- 1.3%, p less than 0.001). Severity of leukoaraiosis around the frontal horns of the lateral ventricles correlated significantly with severity of leukoaraiosis of the centrum semiovale adjacent to the bodies of the lateral ventricles. Cerebral blood flow values for all representative cerebral regions except the parietal white matter were reduced among the patients compared with the normal volunteers. Multivariate regression analysis revealed that reduced cerebral perfusion in the putamen and thalamus correlated significantly with the severity of leukoaraiosis. Cerebral hypoperfusion in territories supplied by deep penetrating arteries may contribute to the pathogenesis of leukoaraiosis.
Muir-Torre syndrome associated with alpha 1-antitrypsin deficiency and cutaneous vasculitis. Report of a case with exacerbation of a cutaneous neoplasm during immunosuppressive therapy. We describe a patient with both Muir-Torre syndrome and alpha 1-antitrypsin deficiency. A keratoacanthoma developed after immunosuppressive therapy for necrotizing vasculitis. To our knowledge, this is the first reported case of Muir-Torre syndrome associated with alpha 1-antitrypsin deficiency.
Perioperative morbidity and mortality of gynecologic brachytherapy. The incidence and nature of perioperative complications associated with gynecologic brachytherapy applications were determined in 462 implants performed on 327 patients with cervical, endometrial, or vaginal cancer from 1986 to 1988. Twenty-one patients (6.4%) had life-threatening complications, including cardiac (16 patients), thromboembolic (4 patients), and pulmonary (1 patient) events. Three complications (0.9%) were fatal within the first 30 days, and two patients died of delayed sequelae of perioperative complications; thus, there was an overall 1.5% mortality rate. Patients experiencing life-threatening complications tended to be older (P = 0.0002), and to have a history of cardiac disease (P = 0.0002) and an increased American Society of Anesthesiology (ASA) score (P = 0.003). Logistic analysis demonstrated that a history of cardiac disease and increased age were independent predictors of life-threatening complications (P = 0.01). Careful patient selection and intensive perioperative care of the high-risk patient may prove to substantially diminish these complications.
Demonstration of viraemia patterns in haemophiliacs treated with hepatitis-C-virus-contaminated factor VIII concentrates. Sequential serum samples from previously untreated haemophiliacs in whom non-A, non-B hepatitis (NANBH) developed after they received factor VIII concentrate contaminated with hepatitis C virus (HCV) were tested by a commercial assay for the presence of antibodies to the C100 protein of HCV (anti-C100) and by "nested" PCR for the presence of HCV RNA sequences. Three temporal patterns of viraemia were observed: transient viraemia in acute resolving NANBH; viraemia lasting for several years in chronic NANBH; and intermittent viraemia in chronic NANBH, with an initial transient phase followed by recurrence after many months. In three of five cases the initial detection of serum HCV RNA was made before the onset of liver function test abnormality, many weeks or months before anti-C100 seroconversion. Diagnosis of acute HCV infection may therefore be possible much earlier by PCR than by existing serological techniques, but the timing of samples may be critical.
Twenty-four-hour activity of felodipine extended release in chronic stable angina pectoris. To investigate the antiischemic efficacy and duration of action of the dihydropyridine calcium antagonist felodipine, 15 patients with stable exertional angina were enrolled in a double-blind, crossover study comparing 2 doses (5 and 10 mg) of felodipine extended release (ER) and placebo given once daily for 1 week. Bicycle exercise tests were repeated at the end of each treatment period 4 and 24 hours after dosing. Four hours after dosing with both felodipine doses, only 5 patients discontinued the exercise test because of greater than 2 mm of ST-segment depression, whereas 10 continued until exhaustion (p less than 0.01 vs placebo). Compared with placebo, total exercise time was increased by 19% (p less than 0.001), with no difference between doses. After 24 hours, exercise duration was prolonged up to physical exhaustion in 6 patients taking felodipine 10 mg (p less than 0.05 vs both placebo and felodipine 5 mg); moreover, 11 patients taking 10 mg and 5 taking 5 mg increased time to 1 mm of ST depression greater than or equal to 15% compared with exercise time during the placebo test. Mean time to 1 mm of ST depression at 24 hours was increased by 8% with 5 mg and by 18% with 10 mg (p less than 0.001 vs placebo; p less than 0.01 between doses). Total exercise time at 24 hours was increased with both doses (p less than 0.001), with greater efficacy with the 10-mg dose (p less than 0.05 vs 5 mg).