shukoor65/lab-rag-model huggingface dataset:
Stress gastritis revisited. In current ICU populations, overt bleeding from stress gastritis occurs in 10% to 20% of patients. Bleeding rates may be reduced to about 3% in patients receiving prophylactic therapy. Although patients with bleeding have higher mortality rates than other critically ill patients, it is not clear that the mortality rate is improved with prophylactic therapy, as most patients die from their underlying disease. As new complications of prophylactic therapy are identified, better definitions of the population at risk to develop complications of stress gastritis will be necessary to select those patients who will benefit most from prophylactic therapy.
Extra-anatomic bypass of failed traumatic arterial repairs. Arterial injuries are best treated by primary repair or anatomically placed interposition grafts. Occasionally, these repairs fail due to adverse local factors, such as soft-tissue infection or enteric contamination. In these instances, limb salvage may require extra-anatomic arterial reconstruction. Between 1979 and 1989, 13 extra-anatomic bypasses were performed in ten male patients following nine failed primary repairs and one ligation of a traumatic arterial injury. The sites of arterial injury were: aorta (two), iliac (five), femoral (two), popliteal (one). Enteric contamination was present at initial operation in six patients; the remaining four had sustained massive soft-tissue injury. Reoperation was required for hemorrhage (seven), pseudoaneurysm (two), and arteriovenous fistula (one). All patients had developed local wound problems that militated against another anatomic repair. Extra-anatomic bypasses performed were: axillo-femoral (three), femoro-femoral (four), obturator (one), and two extra-anatomic femoral to popliteal saphenous vein grafts routed around an infected field. A second extra-anatomic reconstruction was performed for recurrent hemorrhage in three patients, (axillo-femoral--two, obturator--one). One patient with a neuropathic extremity and a functioning graft underwent amputation at 2 months following the initial injury. Two patients died of systemic sepsis. Seven patients (70%) have functional extremities with intact pulses at 2 to 24 months post bypass (mean, 7 months). Limb salvage after secondary disruption of secondarily infected arterial repairs can be achieved by appropriate extra-anatomic arterial reconstruction. In such cases, limb loss is due to soft-tissue sepsis or neuro-skeletal injuries and not vascular insufficiency.
Microbiological analysis of sepsis complicating non-surgical biliary drainage in malignant obstruction. Cholangitis with sepsis is a common complication of non-surgical biliary drainage and represents a difficult management problem. Microbiological data for 18 septic episodes in 15 patients following endoscopic biliary drainage (EBD) and 14 septic episodes in 14 patients following percutaneous transhepatic drainage (PTD) were reviewed. In the EBD group, all 18 patient episodes of sepsis had blood cultures and 10 had bile cultures obtained. In total, 17 gram-negative isolates and 5 gram-positive isolates were grown in the EBD sepsis group. All of the 14 PTD patients had bile cultures and 13 had blood cultures. In total, 23 gram-negative isolates and 26 gram-positive isolates were grown in the PTD sepsis group. When PTD cultures were compared with EBD cultures, there were significantly more gram-positive cultures (26 vs. 5) associated with PTD sepsis than EBD sepsis (p less than 0.0005). Analysis of the antibiotic sensitivities revealed that a combination of ticarcillin clavulanate with gentamicin covered 20 of the 22 (91%) EBD organisms and 38 of the 49 (78%) PTD organisms. Based on this data, ticarcillin clavulanate with gentamicin is the therapy of choice for EBD and PTD sepsis at our institution.
Anaesthetic-induced ventricular tachyarrhythmia in Jervell and Lange-Nielsen syndrome. A four-year-old deaf girl with a history of convulsions developed polymorphous ventricular tachycardia during induction of anaesthesia. The arrhythmia reverted to sinus rhythm spontaneously. Post-anaesthetic ECG showed marked prolongation of the QTc interval (570-690 msec). Deafness and prolonged QTc interval in association with microcytic-hypochromic anaemia confirmed the diagnosis of the Jervell and Lange-Nielsen syndrome. This case report highlights the potentially lethal complication of halothane anaesthesia in patients with long QTc interval syndrome.
Reduction of myocardial infarction after emergency coronary artery bypass grafting for failed coronary angioplasty with use of a normothermic reperfusion cardioplegia protocol. Emergency coronary artery bypass grafting is necessary in 2.7% to 13.5% of patients undergoing elective percutaneous transluminal coronary angioplasty. Myocardial infarction develops in 11% to 49% of these patients, with 18% to 46% of infarcts resulting in new Q waves. Since February 1987 a revised protocol for myocardial preservation has been used in 19 patients undergoing emergency bypass grafting for failed angioplasty. Cardioplegia is induced with a normothermic blood cardioplegic solution. Multiple maintenance doses of cold (4 degrees C) blood cardioplegic solution are then delivered through the aortic root and vein grafts. Before the aortic crossclamp is removed, normothermic reperfusion cardioplegic solution is delivered through the aortic root and vein grafts. This group was compared with all patients undergoing emergency bypass grafting for failed angioplasty before February 1987. These 45 patients received cold induction of cardioplegic solution, multiple maintenance doses of cold cardioplegic solution, and no reperfusion cardioplegic solution. The prevalence of myocardial infarction in the group receiving cold cardioplegic solution was 65% versus 26% in the group receiving normothermic cardioplegic solution (p less than 0.007). Multivariate analysis identified the use of the normothermic cardioplegia protocol (p less than 0.005), nontotal occlusion of the angioplasty vessel (p less than 0.03), and presence of collateral flow to the angioplasty vessel (p less than 0.04) as being independently associated with absence of myocardial infarction.
The lower trapezius island musculocutaneous flap revisited. Report of 45 cases and a unifying concept of the vascular supply. The lower trapezius island musculocutaneous flap is valuable in head and neck reconstruction. It offers thin, pliable tissue and a long arc of rotation to reach virtually any defect in the head and neck. Recent reports have shown unacceptably high rates of failure and have questioned the reliability of the vascularity. We report our experience with 45 reconstructions using the lower trapezius island musculocutaneous flap. The literature is reviewed and the vascular anatomy is described in detail. The concept of angiosomes is applied to the trapezius muscle to help explain the reasons for flap failure and to provide guidelines for flap design and harvest.
Perioperative chemotherapy in oral cancer. This is an interim report of a study of perioperative adjuvant chemotherapy following radical surgery for oral cancer, based on the hypothesis of Goldie and Coleman. 135 patients of alveolobuccal carcinoma, clinically stage III and IV, were entered on the protocol. After a curative resection, they were randomized. The test arm received methotrexate 50 mg/m2 on the 3rd, 10th, and 17th postoperative days. The control arm was only observed. This analysis at 12 months showed a disease free survival of 71% in the test arm vs. 45% in the control arm, which is statistically highly significant (P less than 0.01). Analysis of recurrence pattern showed that recurrence at the primary site was dramatically reduced during the first 6 postoperative months (P less than 0.01). Our study provided further clinical evidence in support of the concepts of Goldie and Coleman that the timing of chemotherapeutic drugs is very critical for a successful end result.
Comparative evaluation of acid- and bile-induced damage to pedicled jejunal or colonic segments in the rat. The choice of the esophageal substitute after surgical resection for peptic stricture lies between the colon and jejunum. The current study was designed to compare long-term resistance of the colonic and jejunal mucosa to gastric or mixed duodenogastric secretions. The following preparations were performed in Wistar rats: transposition of a colonic or jejunal patch (a) to the gastric body, with or without truncal vagotomy, or (b) to the gastric antrum and proximal duodenum, with or without truncal vagotomy. Jejunal and colonic patches were removed 4, 8, and 12 months after surgery. The only damage to the transposed mucosae was the alteration of microvilli. The alteration was more severe in colonic than in jejunal patches and was prevented by truncal vagotomy. Long-term resistance of the transposed mucosae to the environmental challenge may depend on their adaptation potentiality, involving both specific and nonspecific mechanisms. Nonspecific mechanisms include the increased production of mucus and the gastric-like transformation of the superficial epithelial layer. Specific mechanisms include the reduction of the mucosal surface size for jejunal segments and the shifting in mucin secretion patterns for colonic segments.
Are history and physical examination a good screening test for sleep apnea? OBJECTIVE: To determine whether presenting clinical history, pharyngeal examination, and the overall subjective impression of the clinician could serve as a sensitive screening test for sleep apnea. DESIGN: Blinded comparison of history and physical examination with results of nocturnal polysomnography. SETTING: Sleep clinic of a tertiary referral center. PATIENTS: A total of 410 patients referred for suspected sleep apnea syndrome. Most patients reported snoring. MEASUREMENTS: All patients were asked standard questions and given an examination relevant to the diagnosis of the sleep apnea syndrome, and all had full nocturnal polysomnography. Patients with more than ten episodes of apnea or hypopnea per hour of sleep were classified as having sleep apnea. Stepwise linear logistic regression was used to develop two predictive models of sleep apnea: one based on the presence of characteristic clinical features, age, sex, and body mass index; and one based on subjective clinical impression. RESULTS: The prevalence of sleep apnea in our patients was 46%. Only age, body mass index, male sex, and snoring were found to be predictors of sleep apnea. The logistic rule discriminated between patients with and without sleep apnea (receiver operating characteristic [ROC] area, 0.77 [95% Cl, 0.73 to 0.82]). For patients with a predicted probability of apnea of less than 20%, the clinical model had 94% sensitivity and 28% specificity. Subjective impression alone identified correctly only 52% of patients with sleep apnea and had a specificity of 70%. CONCLUSIONS: In patients with a high predicted probability of the sleep apnea syndrome, subjective impression alone or any combination of clinical features cannot serve as a reliable screening test. However, in patients with a low predicted probability of sleep apnea, the model based on clinical data was sufficiently sensitive to permit about a 30% reduction in the number of unnecessary sleep studies.
Serum tumor necrosis factor-alpha concentrations in children hospitalized for acute lower respiratory tract infection. Tumor necrosis factor-alpha (TNF alpha) concentrations were measured by radioimmunoassay in sera of 118 children (median age, 1.7 years; range, 2 months-15 years) hospitalized for acute lower respiratory tract infection (ALRI). Both viral and bacterial ALRI were associated with elevated concentrations of TNF alpha. Concentrations greater than 40 ng/l were seen in children with bacterial or mixed ALRI in 64% and with viral ALRI in 50% of cases. Elevated concentrations were associated with longer duration of fever before admission (P less than .05) and with a higher serum C-reactive protein concentration (P less than .05). There were no significant differences in TNF alpha concentrations between gram-positive and gram-negative infections, nor was there an association with clinical severity of ALRI. TNF alpha concentrations decreased in most patients to normal within 5 days of hospitalization, irrespective of the etiology of the infection.
Exercise testing and left main coronary artery stenosis. Can patients with left main disease be identified? Exercise testing is commonly used to evaluate patients with coronary artery disease who have serious anatomic characteristics. To study the characteristic exercise test variables in patients with left main coronary artery disease, the computerized data base of the Hungarian Institute of Cardiology Exercise Test Laboratory was used. Among 2,378 patients who had undergone a supine bicycle exercise test and who had abnormal coronary angiographic results, 65 patients with significant (greater than 50 percent diameter narrowing) stenosis of the left main coronary artery were found. The 65 patients were subgrouped according to their previous history and other vessel involvement. Nine patients had isolated left main coronary artery disease and no myocardial infarction (group 1); 28 patients had left main coronary artery stenosis and another diseased vessel but no prior myocardial infarction (MI) (group 2); and 28 patients had left main coronary artery disease, another diseased vessel, and a prior MI (group 3). For comparison, the 27 patients selected to be the control group (group C) had no history of MI but had significant stenosis of both the left anterior descending and the left circumflex arteries. Exercise time, calculated oxygen consumption, maximal work load, time to ST depression, prevalence of ST segment depression, and maximal ST depression were similar in the groups. Maximal heart rate and double product were higher in group 1, but we could find no single variable or group of variables characteristic of left main coronary artery disease.
A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer. Fifty-four pediatric cancer patients were studied to determine the relative efficacy of two forms of behavioral intervention for reducing chemotherapy-related distress. Following baseline assessment, subjects were randomly assigned to receive either hypnosis, non-hypnotic distraction/relaxation, or attention placebo (control) during the subsequent identical chemotherapy course. Observational and interview measures of anticipatory and postchemotherapy nausea, vomiting, distress, and functional disruption served as outcome data. Results indicated that treatment condition was the single best predictor of change from baseline to intervention, with children in the hypnosis group reporting the greatest reduction of both anticipatory and postchemotherapy symptoms. The cognitive distraction/relaxation intervention appeared to have a maintenance effect in which symptoms did not get much worse or much better, while children in the control group had symptoms that consistently became worse over time. Emetic potential of the chemotherapy and the prophylactic use of antiemetics each appeared to contribute to the overall severity of symptoms. While the efficacy of hypnosis in the management of chemotherapy distress is supported, the complexities of interacting biologic and psychologic factors are highlighted.
Fatal puerperal cerebral vasospasm and stroke in a young woman. A woman who experienced postpartum cerebral infarction, brain edema, and death is described. Angiography implicated cerebral vasospasm as the primary etiology.
First-line management of sinusitis: a national problem? Overview. Traditional concepts of sinus disease as primarily involving the maxillary sinuses are giving way to understanding of the primary involvement of the ostiomeatal complex. Recognition of predisposing factors is also improving, as is localization of disease in the ethmoid, maxillary, frontal, and sphenoid sinuses. Because of the interdependence of the sinuses, acute sinusitis is rarely limited to one sinus. The diagnosis of acute disease is relatively easy compared with that of chronic sinusitis, which mimics many other conditions. Antibiotics and decongestants typically constitute initial therapy for acute sinusitis, and surgery is reserved for patients with threatened complications. The principal goal of this symposium is to outline the most rational approach to treatment of sinus disease on the basis of currently available diagnostic and therapeutic techniques. Emphasis will be placed on first-line management, on therapeutic response, and on objective evaluation of therapeutic efficiency.
Paroxysmal nocturnal hemoglobinuria with onset in childhood and adolescence. BACKGROUND. Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal hematologic disorder characterized by hemoglobinuria, thrombosis, infection, and a tendency toward bone marrow aplasia. Onset usually occurs in adulthood. Few children and adolescents with PNH have been described, and data on diagnosis, clinical course, and survival in young patients are unavailable. METHODS. We retrospectively reviewed clinical and laboratory data on all patients 21 years old or younger in whom PNH had been diagnosed at Duke University Medical Center from 1966 to 1991. RESULTS. Medical records and clinical follow-up data were available for 26 young patients. Although 50 percent of adult patients present with hemoglobinuria, only four of our patients (15 percent) presented with this feature. In contrast, 15 of our patients (58 percent) had moderate or severe bone marrow failure at presentation, as compared with about 25 percent of adults in cases from the literature; all 26 patients eventually had evidence of bone marrow dysfunction. Eight patients (31 percent) have died, with a median survival of 13.5 years since their initial symptoms. CONCLUSIONS. Children and adolescents with PNH have a greater prevalence of bone marrow failure than do adults with this disorder, and their morbidity and mortality are high. Bone marrow transplantation should be considered for selected young patients with PNH.
Assessment of value of routine bone scans in patients with newly diagnosed prostate cancer. The value of routine bone scans as a staging procedure was assessed in patients with newly diagnosed prostate cancer. Records from 277 patients were reviewed retrospectively to determine the serum acid and alkaline phosphatases, the presence or absence of bone pain, and the results of bone scans and other radiographic studies at the time of initial diagnosis. We determined the sensitivity and specificity of an abnormal acid phosphatase, an abnormal alkaline phosphatase, and the presence of bone pain used in combination for assessing bone metastases. If at least one of these three parameters was present, the sensitivity was 97 percent, whereas if all three tests were normal, the specificity was 78 percent. The negative predictive value for all three tests combined is 99 percent. These results suggest that a routine bone scan to stage patients with newly diagnosed prostate cancer who have no bone pain and normal acid and alkaline phosphatases may not be warranted in all cases.
Hypertensive heart disease in blacks. Although blacks may differ from whites in the response of hypertension to therapy, present data do not suggest that potential racial differences in cardiac structural adaptation to hypertension by themselves mandate a difference in therapeutic strategy. The results of large racially mixed trials of therapy that monitor LV mass regression, such as the VA Cooperative Monotherapy Trial, will be of interest in this regard.
Association of Chlamydia pneumoniae (strain TWAR) infection with wheezing, asthmatic bronchitis, and adult-onset asthma OBJECTIVE--To study the clinical characteristics of respiratory tract illness caused by Chlamydia pneumoniae. DESIGN.-Prospective clinical, bacteriologic, and serologic study. Secondarily, a matched comparison of patients with and without evidence of C pneumoniae infection (serologic titers greater than or equal to 1:64 and less than 1:16, respectively). SETTING.--Four primary care (family practice) clinics in Madison, Wis, and nearby towns. PATIENTS.--The study included 365 white males and females (mean age, 34.2 years). MAIN OUTCOME MEASURES.--Association of acute C pneumoniae infection with signs and symptoms of respiratory illness and the relationship of C pneumoniae antibody titer with wheezing at the time of enrollment in the study, and with the diagnosis of asthmatic bronchitis. RESULTS.--Nine (47%) of 19 patients with acute C pneumoniae infection had bronchospasm during respiratory illness, and there was a strong quantitative association of C pneumoniae titer with wheezing at the time of enrollment in the study (P = .01). In the matched study, C pneumoniae antibody was significantly associated with asthmatic bronchitis after, but not before, respiratory illness (odds ratio, 7.2; 95% confidence interval, 2.2 to 23.4). Four infected patients had newly diagnosed asthma after illness, and four others had exacerbation of previously diagnosed asthma. There was no serologic evidence of coexisting Mycoplasma pneumoniae, Chlamydia trachomatis, or respiratory viral infection in 96% of patients with asthmatic bronchitis and asthma. CONCLUSIONS.--Some C pneumoniae antibody titers, although not diagnostic of chlamydial infection by present criteria, probably represent acute reinfection or ongoing chronic infection. Repeated or prolonged exposure to C pneumoniae may have a causal association with wheezing, asthmatic bronchitis, and asthma.
Pigmented postacne osteoma cutis in a patient treated with minocycline: report and review of the literature. Postacne osteoma cutis is a rare complication of acne vulgaris. If it occurs during a course of tetracycline or minocycline therapy, pigmented osteomas can occur as a result of tetracycline or minocycline bone complexes. We report a case of pigmented postacne osteoma cutis that developed after extensive acne surgery and a 2- to 3-month course of minocycline. Previously reported cases have been treated surgically, but our patient responded to 0.05% tretinoin cream, with transepidermal elimination of some osteomas.
Correlation of motor units with strength and spectral characteristics in polio survivors and controls. The purpose of this study was to determine whether quantitative motor unit analysis in postpolio individuals correlates with muscle strength, endurance, work capacity, or power spectral characteristics of surface EMG and to determine whether power spectrum differentiates postpolio from control subjects. This study was designed to compare these variables in 34 symptomatic postpolio, 16 asymptomatic postpolio, and 41 control subjects. Quantitative motor unit analysis of the quadriceps femoris muscle was performed using a concentric needle electrode. Isometric knee extension peak torque, endurance (time to exhaustion) at 40% of maximal torque, work capacity (tension time index), and recovery of force through 10 minutes post-exhaustion were determined. Median frequency of the surface power spectrum was determined during the above testing. Power spectrum histograms were compared at the onset and termination of endurance exercise. Motor unit action potential variables did not correlate with isometric peak torque, tension time index, endurance time, recovery of strength, or with median frequency. Surface power spectrum did not differentiate postpolio from control subjects.