shukoor65/lab-rag-model huggingface dataset:
Epidemiology of myasthenia gravis in Denmark. A longitudinal and comprehensive population survey. The incidence of myasthenia gravis (MG) was found to be constant in calendar time. The mean annual incidence rate was 4.4 per million population. Age- and sex-specific incidence rates disclosed a bimodal appearance for both sexes, with a peak age at onset located in the early-onset group and another peak for late onset of MG. Early onset of MG appeared 10 years later for male individuals than for female individuals, whereas the peak for late onset of MG was located at the same age for both sexes. It is suggested that the separation between early onset and late onset of MG should be at the age of 50 years for both sexes, rather than at 35 to 40 years as accepted in most studies. The prevalence of MG has increased in time. On January 1, 1988, the point prevalence rate was 77 per million population (female subjects, 96, and male subjects, 57). This reflects an improvement in prognosis despite the fact that life expectancy was found to be significantly lower for MG patients than that of the sex- and age-matched population. The factors causing increased mortality were found to be operative throughout the duration of the disease. Maximum severity of disease was reached within 2 years from onset in 78% of the cases, and more than 50% of all MG-related deaths occurred during the same period. In the course of MG, 70% of all patients experience generalized muscular weakness, and 30% to 40% also suffer from respiratory problems.
Near-infrared spectroscopy in peripheral vascular disease. Near-infrared spectroscopy has been performed on the calf muscles of 38 subjects, 21 normal controls without vascular disease and 17 patients with peripheral vascular disease. Oxygen consumption was measured in the calf by calculating the rate of conversion of oxyhaemoglobin to deoxyhaemoglobin during a period of tourniquet-induced ischaemia. Postischaemic reoxygenation was also measured. Median oxygen consumption in patients with peripheral vascular disease was 0.10 ml 100 g tissue-1 min-1, while in the control group it was 0.20 ml 100 g tissue-1 min-1 (P less than 0.03, Mann-Whitney U test). The median time taken to reach maximum oxyhaemoglobin levels after ischaemia was 40 s in patients with peripheral vascular disease and 20 s in controls (P less than 0.02). The results indicate that oxygen consumption is reduced in peripheral vascular disease. Near infrared spectroscopy is a non-invasive method for assessing metabolic improvement resulting from surgical or pharmacological treatment.
Diagnostic value of video-EEG polysomnography. To investigate the diagnostic value of video-EEG polysomnography (VPSG), we reviewed our experience in 122 patients with suspected parasomnias who underwent one or two nights of VPSG. Of 86 patients without known epilepsy, VPSG provided useful diagnostic information for 41 (69%) of those with a history of prominent motor activity during sleep and for 11 (41%) of those with a history of minor motor activity during sleep. Two children and one adult with clinical histories suggestive of sleep terrors had unequivocal partial seizures during VPSG. Of 36 patients with known epilepsy, VPSG was useful diagnostically in 28 (78%). VPSG is superior to standard polysomnography for the evaluation of parasomnias because of the increased capability to identify and localize EEG abnormalities and to correlate behavior with EEG and polysomnography. VPSG may also be a suitable alternative to intensive inpatient monitoring for some patients with known or suspected epilepsy who have frequent undiagnosed nocturnal spells.
Abdominal aortic aneurysm in chronic thoracic dissection. Report of two cases. Two cases of lower abdominal aortic aneurysm in association with chronic thoracic dissections are reported. These infra-renal aortic aneurysms, superimposed on an abdominal extension of the dissection, always require surgical treatment because of their well known tendency to enlarge and rupture. The authors report their experience and discuss the management of this complication in chronic dissections treated surgically.
Sequestrin, a CD36 recognition protein on Plasmodium falciparum malaria-infected erythrocytes identified by anti-idiotype antibodies. The CD36 molecule expressed by human endothelial cells is a receptor for the adhesion of erythrocytes infected with the human malaria parasite Plasmodium falciparum. A CD36-specific monoclonal antibody, OKM8, inhibits the adhesion of malaria-infected erythrocytes (IRBC) to purified CD36 and cells expressing CD36. Monospecific polyclonal anti-idiotype (anti-Id) antibodies, raised against monoclonal antibody OKM8, expressed determinants molecularly mimicking the CD36 binding domain for the adhesion of IRBC. Purified rabbit anti-Id antibodies reacted with the surface of IRBC by immunofluorescence, directly supported the adhesion of wild-type P. falciparum malaria isolates, and inhibited IRBC cytoadherence to melanoma cells. An approximately 270-kDa protein was immunoprecipitated by the anti-Id antibodies from surface-labeled and metabolically labeled IRBC and was competitively inhibited by soluble CD36. These results support the hypothesis that CD36 is a receptor and the approximately 270-kDa protein, sequestrin, is a complementary ligand involved in the adhesion of IRBC to host-cell endothelium. Sequestrin is a candidate malaria vaccine antigen, and anti-Id antibodies that recognize this molecule may be useful for passive immunotherapy of cerebral and severe P. falciparum malaria.
The office evaluation of infectious diarrhea. Diarrhea is a frequent complaint heard in the office practice of medicine and can represent any of a variety of processes, including several infectious causes. Clues to the infectious processes are reviewed and an approach to their evaluation from history, through physical examination, laboratory evaluation, and initial therapy are discussed.
Prevalence of risk factors for heart disease in OXCHECK trial: implications for screening in primary care. Imperial Cancer Research Fund OXCHECK Study Group. OBJECTIVE--To describe the outcome of offering health checks systematically to a general practice adult population, in terms of age and sex specific prevalence of risk factors, follow up workload, and selective screening of cholesterol concentration. DESIGN--Descriptive analysis of data obtained by postal questionnaire and by personal interview and clinical examination by a trained nurse. SUBJECTS--2205 patients aged 35-64 who attended for a health check in 1989-90 from an invited random sample of 2777 patients from five urban general practices in Bedfordshire. RESULTS--Overall, almost three quarters of patients (78% of men, 68% of women) needed specific advice or follow up. Smoking, a high fat diet, and being overweight (body mass index greater than or equal to 25 kg/m2) were common characteristics exhibited by 35%, 31%, and 55% respectively of men and 24%, 18%, and 48% of women. The total cholesterol concentration was greater than or equal to 6.5 mmol/l in 37% of patients and greater than or equal to 8 mmol/l in 8%. In terms of workload 13% needed dietary advice only, 15% needed only follow up of hyperlipidaemia or hypertension, and 9% needed advice on smoking only. A further 35% needed follow up for a combination of risk factors. The proportion of patients in whom cholesterol concentration would be measured if a selective screening policy were adopted would vary from 29% to 71%, according to different criteria, but (particularly in men) no combination would be much better than random testing as a means to detect patients with a total cholesterol concentration greater than or equal to 8 mmol/l. CONCLUSIONS--If the entire adult population of a practice is offered health checks systematically the acceptance rate is lower and the follow up workload higher than previously understood. The resource implications depend on the age and sex of patients screened and the selective criteria adopted for cholesterol measurement. Health checks are only the beginning of a successful preventive programme--the challenge is to provide effective intervention and follow up.
Intracellular gastrin in human gastrointestinal tumor cells. Flow cytometry and immunohistochemical analyses of the human gastric adenocarcinoma cell line MKN45G identified an intracellular peptide recognized by an anti-gastrin-17 (G17) antiserum but not by an anti-cholecystokinin-specific antiserum. Staining was not associated with the parental line MKN45, of which MKN45G is a clonal variant. The MKN45G cell line had elevated in vitro growth in serum-free medium in which the proliferation of MKN45G cells but not MKN45 cells was reduced to 58% of the control value by treatment with a rabbit anti-G17 antiserum. This inhibition of proliferation was reversed by preabsorbing the antiserum with excess G17. Disaggregated primary human gastric and colorectal tumors were screened for gastrin immunoreactivity by flow cytometry, and 6 of 28 colorectal and 8 of 22 gastric tumors had greater than 20% positively staining cells.
Role of arteriography in the preoperative evaluation of carotid artery disease. This retrospective study was undertaken to determine the role of arteriography in the treatment of patients being considered for carotid endarterectomy. The results of preoperative classification of disease severity by duplex ultrasound and arteriography were compared, and the impact of arteriography on patient management was ascertained. We reviewed the records of 83 patients who had carotid surgery planned on the basis of their clinical history and duplex scan results and who then underwent arteriography. Duplex scan results agreed with the classification of stenosis by arteriography in 87% of evaluated sides and were within one category in 98%. In 87% of the cases reviewed, the clinical presentation and duplex scan findings were sufficient for appropriate patient management. In the instances that arteriography was useful (13%), the need for arteriography was evident when the duplex scan (1) was technically inadequate or equivocal; (2) showed an unusual distribution of disease, atypical anatomy, or a recurrent lesion; or (3) demonstrated an internal carotid artery with diameter-reducing stenosis of less than 50% in a patient with hemispheric neurologic symptoms despite antiplatelet therapy.
Intraocular tissue plasminogen activator in a rabbit model of traumatic hyphema. Tissue plasminogen activator was used to evaluate the clearance of traumatic hyphema in a rabbit model. A neodymium-YAG laser was used to disrupt iris vessels, creating a traumatic hyphema. Tissue plasminogen activator (1800 IU/0.1 mL) was injected into the anterior chamber 24 hours after creation of the hyphema. Two control groups (one receiving balanced salt solution and one receiving no treatment) were used for comparison. A multivariate analysis of covariance indicated that the greatest difference in hyphema clearance between the groups occurred at days 3, 4, and 5. Five days after tissue plasminogen activator treatment, the mean size of the clot remaining in the anterior chamber was 27% of that of the original hyphema. In control eyes, almost 60% of the original clot remained at day 5. Treatment of animals with tissue plasminogen activator doses of 5000 IU and 10,000 IU produced a substantial increase in repeated bleeding episodes in our rabbit model. We concluded that although the use of tissue plasminogen activator in our rabbit model of traumatic hyphema significantly improved clearance of blood from the anterior chamber, the remaining clot was of such size that the clinical benefit was questionable.
Diagnosis and treatment of cranial neuralgias. Both medical and surgical therapies may be used in the treatment of trigeminal neuralgia and glossopharyngeal neuralgia. Ordinarily, the treatment is medical; however, if a response to drugs is not forthcoming, or if the patient becomes toxic while taking medications or refuses to abide by an appropriate medical program, then surgical consultation should be obtained and the appropriate operation performed. The form and type of neurosurgical procedure will probably depend to a considerable extent on the expertise of the neurosurgeon and his training. Generally, in the elderly, the simplest procedure should be attempted first. It may be necessary to employ both medical and surgical procedures in the individual patient. The medical drug of first choice is carbamazepine. Atypical facial neuralgia is a general term used to cover a variety of head and face pains that are poorly defined and that may not deserve separate clinical status. The pathogenesis of the atypical facial neuralgias is uncertain, and multiple causation seems likely. Search for local inflammatory pathology, neoplasms, vasomotor phenomena, and depressive symptoms is indicated. Treatment should be guided by the findings.
Emergency department echocardiography in the diagnosis and therapy of cardiac tamponade. A 44-year-old male presented to the emergency department in shock with jugular venous distension and upper chest cyanosis. Superior vena cava syndrome was ruled out by computed tomography (CT scan). However, a large pericardial effusion was found on CT scan and confirmed by sonography. Pericardial tamponade was diagnosed by emergency physicians and sonography-guided pericardiocentesis was performed with marked improvement in symptomatology.
Interval report of a phase I-II study utilizing multiple modalities in the treatment of invasive bladder cancer. A bladder-sparing trial. Clinicians at the Massachusetts General Hospital have used two cycles of methotrexate, cisplatin, and vinblastine (MCV) before radiotherapy and cisplatin in 53 patients with muscle-invasive bladder cancer. Eleven patients did not complete the protocol, but overall, the toxicity was not formidable. Of the total patients accessioned, 34 are alive. Of the 34 patients in the series who completed the full treatment protocol, the estimated survival rate at 54 months is 77%. This interim analysis suggests that the treatment is achieving at least limited success in saving lives and bladders.
Unsuspected uveal melanoma diagnosed after cataract extraction. Four cases of unsuspected uveal melanoma diagnosed after cataract extraction were found in a review of the records of enucleation specimens processed at our centre between 1974 and 1988. Similarities among the four cases included disparity in loss of visual acuity, unilateral angle-closure glaucoma, asymmetric cataract formation, inability to view the fundus and rapid flattening of the anterior chamber, with difficult closure at the time of surgery. Uveal melanoma should be suspected in any cataract patient presenting with one or more of these atypical clinical findings, and complete investigation, including A-scan and B-scan ultrasonography, is indicated.
Evolving experience with thoracoabdominal aortic aneurysm repair at a single institution. Fifty-seven patients underwent repair of atherosclerotic thoracoabdominal aortic aneurysms between 1978 and 1990. Five patients had urgent surgery for rupture. The 30-day operative mortality rate for the entire group was 18% (10 patients). Before July 1987, 19 patients (group 1) were operated on by use of a technique previously described. In these earlier patients the peritoneum was routinely entered, the diaphragm was divided radially, and no heparin was given. Among patients in group 1 there was a 30-day operative mortality rate of 42% (8 patients), and morbidity included myocardial infarction 4 (21%), respiratory failure 9 (47%), renal failure 12 (63%), bleeding requiring reoperation 4 (21%), and intestinal ischemia 3 (16%). Since July 1987 a standardized approach to all elective thoracoabdominal aortic aneurysms has been used in 38 patients (group 2). This method uses a left thoracoabdominal incision, circumferential division of the hemidiaphragm, retronephric totally extraperitoneal aortic exposure, single lung anesthesia, full heparinization, the graft inclusion technique, and liberal use of visceral endarterectomy. Patients in group 2 sustained a 30-day operative mortality rate of 5% (2 patients) and morbidity included myocardial infarction 2 (5%), respiratory failure 10 (26%), renal failure 11 (29%), bleeding requiring reoperation 1 (3%), paraplegia 6 (16%), and paraparesis 4 (11%). Modern surgery for repair of thoracoabdominal aortic aneurysm results in acceptably low operative mortality rates. Spinal cord ischemia remains an unresolved source of morbidity.
Monoclonality in B cell lymphoma detected in paraffin wax embedded sections using the polymerase chain reaction. The polymerase chain reaction (PCR) was used to develop a simple technique for detecting monoclonality at the DNA level in B lymphocyte populations in formalin fixed, paraffin wax embedded material. Sections were dewaxed and dehydrated, and the DNA was extracted by boiling in water for 45 minutes. A semi-nested PCR was performed to amplify the V-D-J region of the immunoglobulin heavy chain gene. The product was electrophoresed and viewed under ultraviolet light after ethidium bromide staining. Specimens from 26 B cell lymphomas produced a monoclonal band in 24 cases and no amplification in two cases; monoclonality was specific for this disorder. Specimens from seven T cell lymphomas produced no amplification; specimens from nine reactive nodes produced a broad smear of polyclonal material; and specimens from 12 cases of carcinoma produced either no amplification or polyclonal material. As detection of monoclonality is strongly suggestive of neoplastic disease, this technique is likely to be of value in routine diagnosis, because of its speed, simplicity, and applicability to fixed, embedded material.
Infection of the central nervous system due to Acanthamoeba. It is well established that Acanthamoeba castellanii, Acanthamoeba culbertsoni, Acanthamoeba polyphaga, and probably other species of free-living amebas are virulent opportunists capable of producing disease in humans and animals. Human infections involving brain, eyes, skin, and lungs have been reported from all continents. Central nervous system (CNS) infection due to Acanthamoeba species usually occurs in chronically ill, debilitated individuals, some of them receiving immunosuppressive therapy or taking broad-spectrum antibiotics. The disease runs a protracted, insidious clinical course and is known as granulomatous amebic encephalitis. Histopathologically, Acanthamoeba species may produce a multifocal, chronic, or subacute granulomatous encephalitis, with trophozoites and cysts present in CNS lesions. The portal of entry of the amebas into the CNS is probably the respiratory tract or a skin lesion, and the organisms reach the CNS by hematogenous spread. As of 1 January 1989, about 50 cases of granulomatous amebic encephalitis had been reported worldwide, 27 in the United States alone.
Phase II trial of interferon gamma and monoclonal antibody 17-1A in pancreatic cancer: biologic and clinical effects. Thirty patients with advanced measurable pancreatic adenocarcinoma were entered onto a phase II trial with recombinant interferon gamma (Biogen, Cambridge, MA; 10(6) U/m2 daily for 4 days) and monoclonal antibody (Mab) 17-1A (Centocor, Malvern, PA; 150 mg in autologous leukocytes on days 2, 3, and 4 following interferon infusion). The effect of a single interferon gamma treatment on natural and antibody-dependent cellular cytotoxicity (ADCC), Fc receptor occupancy by antibody, and human leukocyte antigen-DR (HLA-DR) expression on monocytes and lymphocytes was also studied. Toxicity was modest and generally limited to grade I to II fever, nausea and vomiting, and hepatotoxicity. Five patients were considered to be nonassessable for response. Of the 25 assessable patients, one objective response (complete remission for a duration of 4 months) was observed. Stable disease for 2 months or greater was noted in nine patients. The median survival for the group was 5 months. Analysis of cytotoxicity data obtained prior to treatment showed reduced natural cytotoxic activity in these patients compared with normal volunteers. A significant improvement in natural cytotoxic activity to normal levels occurred within 24 hours following the interferon gamma infusion. This was also associated with augmented antibody-dependent cellular cytotoxicity. Although HLA-DR expression was not increased on either monocytes or lymphocytes, an increased capacity of both lymphocytes and monocytes to bind Mab 17-1A was observed. In all in vitro assays of ADCC, the presence of antibody excess was associated with improved cytolytic activity. In spite of the favorable modulation of cytolytic activity and improved ability of effector cells to bind Mab, we failed to demonstrated adequate clinical efficacy in the treatment of patients with pancreatic adenocarcinoma using this dose and schedule of interferon gamma and Mab 17-1A. Future trials will focus on alternate schedules of Mab 17-1A with the hope of improving tumor antigen saturation and circulating levels of infused antibody.
Temporalis myofascial flap for maxillofacial reconstruction. To date, the temporalis myofascial flap has been used only to a limited extent for reconstruction in the maxillofacial region. Experience gained with 26 temporalis flaps in reconstruction of tissue defects in the periorbital region, skull base, maxilla, and oral cavity is presented. Only one patient developed total necrosis of the flap; significant necrosis did not occur in any other patient. The anatomy of the flap and surgical technique are briefly presented.
Life-threatening angioedema. Angioedema is a well-recognized edema involving the deeper layers of the skin, subcutaneous tissue, and mucosa. From July 1986 to July 1989 the authors have observed and treated 10 patients admitted to the Medical College of Virginia (MCV) Hospitals in Richmond, Virginia, with life-threatening angioedema as a complication of enalapril or captopril ingestion. Both drugs are angiotensin-converting enzyme (ACE) inhibitors prescribed for antihypertensive activity and the ability to improve symptoms in patients with congestive heart failure. We describe the clinical symptoms, diagnosis, and management of these patients, as well as reasons for each occurrence. Sporadic reports of angioedema secondary to ACE inhibitor therapy have appeared in the literature. This represents the first time a significant series of patients from the same institution have encountered this complication over a short period of time, suggesting that the complication may be much more common than has been thought.
Annular atrophic lichen planus. We describe a case of generalized, asymptomatic, chronic annular lichen planus. The centers of the large annular lesions were atrophic and had lost their elasticity. Histologic examination revealed an absence of elastic fiber in the center. Electron microscopy revealed fragmented elastic fibers. Examination of early lesions showed that elastolysis had already begun in the heavy cellular infiltration. We conclude that the annular configuration resulted from the elastolytic activity of the inflammatory cells with the formation of foci of localized acquired cutis laxa.
Effect of inspired oxygen concentration on the incidence of desaturation in patients undergoing total hip replacement. The effect of inspired oxygen concentration on the incidence of desaturation was studied in two groups of patients (n = 32 and 31) during total hip replacement. During insertion of acrylic bone cement, those patients receiving an inspired fractional oxygen concentration (FIO2) of 0.5 had less desaturation (3%) than those receiving an FIO2 of 0.33 (34%).