shukoor65/lab-rag-model huggingface dataset:
Argon beam coagulation is superior to conventional techniques in repair of experimental splenic injury. Present management of splenic trauma focuses on splenic preservation. However, conventional operative techniques for splenic salvage are time consuming and frequently ineffective. The purpose of this study was to assess the efficacy of the argon beam coagulator (ABC) in the management of experimental splenic injury. Ten adult miniature pigs were randomized to treatment with either conventional surgical techniques (topical Surgicel, electrocautery, suture-ligation, digital pressure) or splenic repair with the ABC. Three standard splenic injuries were made in each pig: capsular avulsion, splenic laceration, and hemisplenectomy. The ABC was more effective in treating all three types of splenic injury. The time required to achieve hemostasis and total operative time were significantly less in the group treated with the ABC for all three types of splenic injuries (p less than 0.05, Student's t-test, two sided). Operative blood loss was significantly less in the group treated with ABC for avulsion and hemisplenectomy (p less than 0.05, Student's t-test, two sided). Recurrent bleeding was significantly higher in the group treated with conventional techniques (p less than 0.001, Fisher's exact test, two-sided). We conclude that the argon beam coagulator is more effective than conventional techniques in treating experimental splenic injuries. The ABC provides more rapid and reliable hemostasis. Clinical trials using the ABC for splenic injury are warranted.
Factors relevant to preventing embolic stroke in patients with non-rheumatic atrial fibrillation. Whether or not to treat patients with non-rheumatic atrial fibrillation with anticoagulants to prevent embolic stroke is a dilemma for physicians. If randomized trials, currently underway, demonstrate a beneficial effect, the dilemma will not be solved because not all of the relevant factors can be addressed by trials. We used current knowledge about non-rheumatic atrial fibrillation and a method of obtaining patient-derived weights for avoiding stroke from eight medically trained subjects, to determine the overall benefit of anticoagulants and to see what factors were relevant and what effect each might have in deciding whether to use anticoagulant therapy. Using standard assumptions, anticoagulants gave an expected benefit for all subjects. The expected benefit (expressed in terms of lives per 1000 saved due to anticoagulants) varied between 5.4 and 46.7. This benefit remained for all subjects when we did a sensitivity analysis for different rates of stroke prevented by anticoagulants and different rates of intracranial hemorrhage caused by anticoagulants. When we used different baseline rates of stroke and different impacts of major hemorrhagic complications the benefit disappeared for 3 and 4 subjects respectively. We found the factors that were most crucial to the decision will not be included in randomized trials; the weight that an individual would place on avoiding embolic stroke vs the risk of intracranial bleeding from anticoagulant therapy; and the rate of embolic stroke that could be expected for the subject at risk. Factors which will be measured in randomized trials, will change results less substantially: the increased risk of major hemorrhages; the proportion of strokes that could be prevented by treatment; the increase in risk of intracranial hemorrhage. This method of analysis suggests that for most patients anticoagulants are beneficial and that the most important factor in determining this result is the value that subjects put on different outcomes.
Sarcoplasmic reticulum-associated cyclic adenosine 5'-monophosphate phosphodiesterase activity in normal and failing human hearts. Sarcoplasmic reticulum-associated cAMP phosphodiesterase activity was examined in microsomes prepared from the left ventricular myocardium of eight heart transplant recipients with end-stage idiopathic dilated cardiomyopathy and six unmatched organ donors with normal cardiac function. At cAMP concentrations less than or equal to 1.0 microM, sarcoplasmic reticulum-associated cAMP phosphodiesterase activity was functionally homogeneous. cAMP phosphodiesterase activity was inhibited competitively by cGMP (Ki = 0.031 +/- 0.008 microM) and the cilostamide derivative OPC 3911 (Ki = 0.018 +/- 0.004 microM), but was essentially insensitive to rolipram. Vmax and Km were 781.7 +/- 109.2 nmol/mg per min and 0.188 +/- 0.031 microM, respectively, in microsomes prepared from nonfailing hearts and 793.9 +/- 68.9 nmol/mg per min and 0.150 +/- 0.027 microM in microsomes prepared from failing hearts. Microsomes prepared from nonfailing and failing hearts did not differ with respect to either the ratio of cAMP phosphodiesterase activity to ATP-dependent Ca2+ accumulation activity or the sensitivity of cAMP phosphodiesterase activity to inhibition by OPC 3911. These data suggest that the diminished inotropic efficacy of phosphodiesterase inhibitors in failing human hearts does not result from changes in the level, kinetic properties, or pharmacologic sensitivity of sarcoplasmic reticulum-associated cAMP phosphodiesterase activity.
Erythropoietin deficiency in acute crescentic glomerulonephritis and in total bilateral renal cortical necrosis. Six patients with acute renal failure, in five cases due to acute crescentic glomerulonephritis and in one case due to total bilateral renal cortical necrosis, were studied. All had serum erythropoietin (EPO) concentrations in the normal range, despite a relatively severe anaemia. Half-life and plasma clearance of intravenously injected recombinant human erythropoietin (rhEPO) were determined. The results indicate that the lack of compensatory increase in serum EPO to the anaemic stimulus is not due to increased catabolism, but to decreased synthesis of the renal hormone. Two patients were treated with rhEPO (Eprex). In marked contrast to untreated controls, both patients responded with vigorous reticulocytosis and normalization of haemoglobin levels while they were still in severe renal failure. These results are similar to our previous findings in patients with acute renal failure due to tubular necrosis. Under all three conditions the defective EPO synthesis is probably the dominant pathogenetic factor for the largely aregeneratory anaemia of prolonged cases, and for the sluggish restoration of red cell mass during recovery of renal function. It is concluded that defective synthesis of EPO is not only a permanent and irreversible feature of severe chronic renal failure, but that it is also present, usually in a transient and reversible form, in different types of acute renal failure.
Chronic sialadenitis with psammoma bodies mimicking neoplasia in a fine-needle aspiration specimen from the submandibular gland. A 65-year-old woman with a submandibular gland nodule had a fine-needle aspiration specimen that contained groups of duct-type cells and a psammoma body, suggestive of adenocarcinoma. The resected gland showed chronic sialadenitis with sialolithiasis and psammoma bodies. In a series of 81 resected nonneoplastic submandibular glands from 72 patients, psammoma bodies, nonlaminated microcalcifications, or both were found in 46 (57%). They were located most commonly just outside of striated or intercalated ducts. When examining fine-needle aspiration specimens from the submandibular gland, it is important that one be aware that psammoma bodies may occur in normal, inflamed, irradiated, and neoplastic conditions.
Deficits in strategy application following frontal lobe damage in man. A quantitative investigation of the ability to carry out a variety of cognitive tasks was performed in 3 patients who had sustained traumatic injuries which involved prefrontal structures. All 3 had severe difficulties in 2 tests which required them to carry out a number of fairly simple but open-ended tasks over a 15-30 min period. They typically spent too long on individual tasks. All patients scored well on tests of perception, language and intelligence and 2 performed well on a variety of other tests of frontal lobe function. Explanations for their difficulty on the multiple subgoal tasks in terms of memory or motivational problems could be excluded. It is argued that the problem arose from an inability to reactivate after a delay previously-generated intentions when they are not directly signalled by the stimulus situation.
Descending thoracic aortofemoral bypass as an alternative for aortoiliac revascularization. We performed descending thoracic aorta to femoral bypass in six selected patients over the past four years. An alternative inflow source was selected because the standard transabdominal approach was contraindicated or considered hazardous. The inflow consisted of a single Dacron tube from the descending thoracic aorta to the left groin, and a femorofemoral bypass to the right groin. There was no operative mortality or major morbidity related to the surgical procedure. After an average follow-up of 17.1 months (range 6 to 23 months), all thoracofemoral grafts remained patent. One patient had repeated occlusions of the femorofemoral graft related to right lower extremity outflow disease, while the remaining five crossover grafts are patent. One patient died 22 months postoperatively from a myocardial infarct, with a patent bypass. Although this series represents a small group of patients, we feel that descending thoracic aortofemoral bypass offers excellent inflow and reliable patency, and is a good alternative when reoperation on the abdominal aorta is undesirable. This procedure may also be considered for conversion of an axillofemoral bypass that has failed repeatedly.
The European Stroke Prevention Study (ESPS): results by arterial distribution. The European Stroke Prevention Study was a multicenter study comparing the effect of the combination of dipyridamole, 75 mg, and acetylsalicylic acid, 330 mg, three times a day, to that of placebo in 2,500 patients in the secondary prevention of stroke or death after one or more transient ischemic attacks, reversible ischemic neurological deficits, or strokes of atherothrombotic origin. The patients with vertebrobasilar events at entry comprised one-third of the whole patient population. The overall total incidence of stroke or death (the end points) during the 2-year follow-up in the placebo group was lower in the vertebrobasilar group compared to the carotid group (14% versus 24%, respectively). The combination therapy of dipyridamole and acetylsalicylic acid caused a marked reduction in the incidence of stroke or death in patients with vertebrobasilar (51%) and carotid (30%) events. When only stroke was considered as the end point, dipyridamole and acetylsalicylic acid seemed to be more effective in reducing the risk of transient ischemic attacks than stroke, and more effective in men than in women.
Intravenous adenosine: continuous infusion and low dose bolus administration for determination of coronary vasodilator reserve in patients with and without coronary artery disease. To assess the use of adenosine as an alternative agent for determination of coronary vasodilator reserve, hemodynamics and coronary blood flow velocity were measured at rest and during peak hyperemic responses to continuous intravenous adenosine infusion (50, 100 and 150 micrograms/kg per min for 3 min) and intracoronary papaverine (10 mg) in 34 patients (17 without [group 1] and 17 with [group 2] significant left coronary artery disease), and in 17 patients (11 without and 6 with left coronary artery disease) after low dose (2.5 mg) intravenous bolus injection of adenosine. The maximal adenosine dose did not change mean arterial pressure (-10 +/- 14% and -6 +/- 12% for groups 1 and 2, respectively) but increased the heart rate (15 +/- 18% and 13 +/- 16, respectively). For continuous adenosine infusions, mean coronary flow velocity increased 64 +/- 104%, 122 +/- 94% and 198 +/- 59% and 15 +/- 51%, 110 +/- 95% and 109 +/- 86% in groups 1 and 2, respectively for each of the three doses. Mean coronary flow velocity increased significantly after 100 and 150 micrograms/kg of adenosine and 10 mg of intracoronary papaverine (48 +/- 25, 52 +/- 19 and 54 +/- 21 cm/s, respectively; all p less than 0.05 vs. baseline) and was significantly higher than in group 2 (37 +/- 24, 32 +/- 16, 41 +/- 23 cm/s; all p less than 0.05 vs. group 1). The coronary vasodilator reserve ratio (calculated as the ratio of hyperemic to basal mean flow velocity) for adenosine and papaverine was 2.94 +/- 1.50 and 2.94 +/- 1.00, respectively, in group 1 and was significantly and similarly reduced in group 2 (2.16 +/- 0.81 and 2.38 +/- 0.78, respectively; both p less than 0.05 vs. group 1). Low dose bolus injection of adenosine increased mean velocity equivalently to that after continuous infusion of 100 micrograms/kg, but less than after papaverine. There was a strong correlation between adenosine infusion and papaverine for both mean coronary flow velocity and coronary vasodilator reserve ratio (r2 = 0.871 and 0.325; SEE = 0.068 and 0.189, respectively; both p less than 0.0005). No patient had significant arrhythmias or prolongation of the corrected QT (QTc) interval with adenosine, but papaverine increased the QT (QTc) interval from 445 +/- 44 to 501 +/- 43 ms (p less than 0.001 vs. both maximal adenosine and baseline) and produced nonsustained ventricular tachycardia in one patient.(ABSTRACT TRUNCATED AT 400 WORDS).
Continuous vectorcardiography in cardiac surgery: natural course of vector changes and relationship to myocardial oxygen uptake. Continuous vectorcardiography was registered before and during the first 18 hours after cardiac surgery in 53 patients. QRS vector changes (QRS-VD) occurred during the operation, but no further changes were observed postoperatively. The ST vector (ST-VM) increased during the operation, and a further slight increase occurred postoperatively. Perioperative myocardial infarction occurred in three patients. Their ST-VM was higher than the average in patients without myocardial infarction, while QRS-VD did not differ from the average pattern. Twelve other patients were studied in pacemaker-induced moderate tachycardia. QRS-VD increased in proportion to heart-rate changes (rs median = 0.93, p less than 0.01). QRS-VD also correlated with myocardial oxygen uptake (rs median = 0.62, p less than 0.05). The ST-VM responses were not uniform. The data suggest that vectorcardiogram variables can provide information related to myocardial energy metabolism.
Value of electrocardiographic leads MCL1, MCL6 and other selected leads in the diagnosis of wide QRS complex tachycardia. To compare the modified precordial leads MCL1 and MCL6 with the conventional precordial leads V1 and V6 and assess the diagnostic accuracy of selected leads for continuous bedside electrocardiographic (ECG) monitoring, 121 wide QRS complex tachycardias were recorded from 92 patients during cardiac electrophysiologic study. As ascertained from intracardiac recordings, 86 tachycardias were ventricular and 35 were supraventricular with aberrant conduction. Early or late peaking of the predominant QRS deflection in lead MCL6 or V6 proved valuable in diagnosing wide complex tachycardia. An interval of less than or equal to 50 ms from the onset of the QRS complex to the predominant peak (or nadir) indicated supraventricular tachycardia; an interval of greater than or equal to 70 ms indicated ventricular tachycardia. The QRS complexes in leads MCL1 and MCL6 were comparable to those in leads V1 and V6 during sinus rhythm. Significant discrepancies in QRS configuration occurred between the modified and conventional precordial leads during ventricular tachycardia, especially between leads MCL1 and V1; however. these differences did not affect diagnostic accuracy. A single MCL1, V1, MCL6 or V6 lead was equally valuable in the diagnosis of wide complex tachycardia and far superior to a single lead II. A combination of leads (MCL1 + MCL6), (V1 + V6), (V1 + I + aVF) or (V1 + V6 + I + aVF) was superior to a single lead or the routinely monitored lead V1 + II combination.
Multiple luteinizing hormone/chorionic gonadotropin receptor messenger ribonucleic acid transcripts. It has previously been shown that multiple messenger RNA (mRNA) species can be identified in gonadal tissues by probes specific for the LH/CG receptor. Here we show that the sizes and relative abundancies of gonadal LH/CG receptor transcripts are quite variable between such closely related species as rat and mouse. These patterns of LH/CG receptor mRNAs are yet different from that observed in human embryonic kidney 293 cells that have been transfected with a cDNA encoding for the rat luteal LH/CG receptor. In spite of the diversity in the number and sizes of LH/CG receptor mRNA transcripts, however, our data also show that the size of the cell surface receptor expressed in these three cells/tissues is identical. We further show that the most abundant LH/CG receptor mRNA present in MA-10 cells, a clonal strain of cultured Leydig tumor cells, is a 1.2 kilobase transcript which encodes for a truncated version of the LH/CG receptor corresponding to the extracellular hormone-binding domain. It does not appear, however, that this transcript is translated into a functional protein.
Cytomegalovirus infection of the appendix in patient with the acquired immunodeficiency syndrome. Disseminated cytomegalovirus infection occurs predominantly in immunocompromised hosts. Involvement of the gastrointestinal tract in the acquired immunodeficiency syndrome is frequent, but to our knowledge there is only one report of involvement of the appendix. In this study, a patient with a history of the acquired immunodeficiency syndrome who presented with fever and an acute abdomen is described. At surgery, appendicitis was found. In the surgical specimen, appendicitis and cytomegalovirus infection were found. Cytomegalovirus should be considered as a possible cause of appendicitis in the acquired immunodeficiency syndrome.
Echo Doppler duplex scanner and color in the study of portal hypertension. In the present state of the art, the Doppler duplex scanner provides much information about portal hypertension and its associated pathology, liver cirrhosis, hepatic malformations, vascular or avascular structures, hepatic transplants, and ascites. Its usefulness for experimental studies, providing new insight into the pathophysiology of this disease, has been proven. It is limited by the subjectivity of the conclusions, and by its poor feasibility in fat patients and those with excessive abdominal gas. However, the noninvasive nature of Doppler and its relative low cost make it a useful first step in the evaluation of portal hypertension.
Anismus in patients with normal and slow transit constipation. This study examined differences in anorectal function, with particular reference to anismus, which might explain why some patients with intractable constipation have slow and others have normal whole gut transit times. Twenty-four patients were studied; 13 with slow transit (all female, median age 32 years, range 16-52 years) and 11 with normal transit (eight women, three men, median age 37 years, range 21-60 years). Videoproctography with synchronous sphincteric electromyography and anorectal manometry was performed. There were no differences between the two groups, suggesting that slow transit constipation is not secondary to any abnormality in anorectal function and may therefore be a primary disorder of colonic motility. There was no correlation between electromyographic evidence of anismus (pelvic floor contraction on defaecation) and the ability of the patient to evacute the rectum or symptoms of obstructed defaecation. Electromyography findings alone can be misleading and should be related to proctographic evidence of incomplete rectal evacuation before functional anismus can be said to be present.
Informing schools about children's chronic illnesses: parents' opinions. Parents of 217 chronically ill children and adolescents were surveyed concerning their opinions about disclosing medical information to schools. The sample consisted of parents of more than one third of the children and adolescents meeting inclusion criteria who were seen at a university-based pediatric clinic during a 10-week period. Parents were asked (1) whether schools need information about 16 health items, (2) who in the school should know, and (3) who should provide this information. Parents' willingness to disclose information was compared with family and child demographic data. Parents strongly believed that (1) teachers need to be informed and (2) parents should be the primary informers. The consensus that schools need information did not vary with family and child demographics. However, parents of children with poor illness prognosis, greater likelihood of emergencies, and visible illnesses were more supportive of disclosure. Most parents indicated that physicians should provide information on 10 of the 16 items. Physicians were viewed as particularly appropriate informers about recognizing emergencies and medication effects. Only 21% of the parents were aware of any prior contact between the medical care giver and the school concerning their child's illness. Thus, parents want schools informed and believe physicians should be involved in providing information.
Dipyridamole echocardiography. A new diagnostic window on coronary artery disease. Dipyridamole echocardiography testing is a highly feasible, inexpensive, and safe diagnostic tool, with excellent specificity and good sensitivity--especially in patients with multivessel disease and/or resting dyssynergy--for the diagnosis of coronary artery disease. The test does not offer an "all or none" binary result but rather a complex stratification of the ischemic response along the coordinates of time and space, accurately identifying the degree of physiological impairment of coronary reserve, the severity and extent of coronary disease, the geographic location of the area at risk, and the prognostic outlook. It offers highly competitive diagnostic information versus more sophisticated, time-consuming, and costly radionuclide techniques; in comparison with other stress echocardiography techniques, it is more feasible than exercise and less invasive and better tolerated than pacing. The electrocardiogram usefully integrates the information provided by the mechanical marker of ischemia during dipyridamole testing. The finding of echocardiographically silent ST segment depression represents a clue to the identification of angiographically normal coronary arteries. On the basis of this evidence, dipyridamole testing with two-dimensional echocardiography and 12-lead electrocardiography can be considered a reasonable choice for the exercise-independent diagnosis of coronary artery disease.