shukoor65/lab-rag-model huggingface dataset:
Determinants of sciatica and low-back pain. Several factors were studied for their association with the prevalence of chronic low-back syndromes, sciatica, and unspecified low-back pain (LBP) in 2,946 women and 2,727 men (age range, 30-64 years) participating in the Mini-Finland Health Survey, a project aimed at comprehensive evaluation of the population's health. On the basis of a standardized clinical examination, a physician diagnosed sciatica in 5.1% and LBP in 11.6% of the subjects. Those with a previous traumatic back injury had a 2.5-fold risk of having sciatica or LBP. The fractions of sciatica and LBP attributable to such back injuries were estimated to be 16.5% and 13.7%, respectively. Sum indices of both physical and mental stress at work were found to be directly proportional to the prevalence of sciatica and LBP. Smokers had an increased risk of LBP, and body height was related positively to the prevalence of sciatica. These associations, however, were inconsistent between sex and age subgroups. In the presence of osteoarthritis in the knee, hip, or hand, LBP was prevalent (adjusted odds ratio [OR], 5.3; 95% confidence interval [CI], 4.1-6.9), but sciatica was not (OR, 1.1; 95% CI, 0.7-1.7). Diabetics were found to have a significantly decreased prevalence of LBP (OR, 0.4; 95% CI, 0.3-0.8). Many factors, independent of each other, determine the occurrence of chronic low-back syndromes. The determinants of sciatica and LBP are different to some extent.
Oral contraceptive use and coronary risk factors in women. The relationship between oral contraceptive use and other coronary artery disease risk factors was examined in 215 nonsmoking women grouped as never, current, or previous users. Current oral contraceptive users had higher triglyceride levels (p less than or equal to 0.001) than other groups, higher systolic blood pressure, and lower plasma HDL-cholesterol levels (p less than or equal to 0.05) than previous users. The effect of oral contraceptive use on plasma triglyceride values persists on multivariate regression analysis independently of age, body mass index, dietary sodium and cholesterol intake, cigarette smoking, and level of physical activity. Oral contraceptive use also has an independent relationship to the plasma total cholesterol/HDL- cholesterol ratio. These findings indicate that oral contraceptive use is adversely associated with plasma lipid and lipoprotein values.
Formation and spontaneous closure of an arteriovenous fistula after transvenous pacemaker placement. We report the findings in a patient with the unusual complication of arteriovenous fistula formation of the subclavian vessels seven weeks following placement of a dual-chamber pacemaker. The fistula's subsequent course was equally unusual, closing spontaneously three weeks later. It is postulated that the thrombotic and fibrotic reaction elicited by the leads contributed to the fistula's closure. Two surgical procedures, correction of the fistula and reimplantation of the pacemaker, were thus avoided by careful monitoring of the patient.
Ileal segment for ureteral substitution or for improvement of ureteral function. A total of 29 patients received an ileal segment interposition between the upper and lower urinary tract for partial or total ureteral substitution, or for ileal wrapping around a massively dilated, aperistaltic ureter. Indications for an operation included the presence of an extensively diseased or short ureter and an aperistaltic megaureter that had failed previous reconstructive attempts. Nine patients (group 1) underwent an ileal sleeve procedure in an attempt to increase the ureteral peristaltic activity and facilitate drainage. Among these patients 7 (78%) had a stable upper tract radiologically and normal serum creatinine (less than 1.6 mg./100 ml.), while 2 (22%) had deterioration of the renal function. Ten patients (group 2) had undergone a myriad of reconstructions that failed and then underwent complete ureteral substitution with ileum. Among them, renal function (as evidenced by excretory urography and serum creatinine) is stable in 7 (70%) and deteriorated in 3 (30%). In 10 patients (group 3) the ureters were partially replaced by ileum in addition to a bladder augmentation procedure. Of these patients 8 (80%) have stable renal function and 2 (20%) had renal failure. Over-all, 7 patients have different degrees of renal failure; among them 2 (6.9%) are on dialysis and 2 (6.9%) have received a transplanted kidney. In groups 2 and 3 the results with an antireflux operation indicated that among 6 ureteroileal reimplantations 5 (83%) were successful, among 12 intravesical intestinal nipples 6 (50%) failed to prevent reflux and there was no case of obstruction, while among 4 ileocecal intussusceptions 2 (50%) were successful and 2 failed. Mucous secretion produced temporary ureteral obstruction in 1 ureter (3.4%), which resolved without surgical intervention. Some of the aforementioned procedures were done in the past and in some situations a different reconstructive technique would be considered presently. The surgical complexity and magnitude of the procedures justify their performance only in difficult clinical situations as an alternative to urinary diversion or renal autotransplantation.
Comparison of cellular protooncogene activation and transformation-related activity of human melanocytes and metastatic melanoma. Two cell lines (NH and HM1), established from patients with metastatic melanomas, were evaluated for the presence of activated cellular protooncogenes. Northern blot analysis demonstrated increased expression of the c-myc gene (from 9 to 14 times) in NH and HM1 cell lines by densitometric comparison with human melanocyte cell lines. Analysis of the expression of 13 additional cellular protooncogenes revealed either no detectable levels (c-fms, c-abl, v-src, c-erb A1, c-erb B, v-mos, TGF beta, and c-myb) or unaltered expression levels (cH-ras, N-ras, c-fos, and c-sis) in normal human melanocytes and metastatic melanomas. Elevated expression of the c-myc gene was also detected in two long-term cultured melanoma cell lines (RPMI 7951 and SKMEL-30). Analysis of c-myc expression by in situ hybridization in HM1 cells showed that expression was not localized to a sub-population of cycling cells and all cells were overexpressing c-myc mRNA. Differences in relative abundance of c-myc transcripts suggests a relationship with the ability of DNA from these cell lines to efficiently transform NIH 3T3 cells and form colonies on soft agar.
Assessment of systemic effects of different ophthalmic beta-blockers in healthy volunteers. Systemic beta-blockade after single doses of ophthalmic beta-blockers (one drop in each eye) was investigated in healthy volunteers in two randomized, double-blind, crossover, placebo-controlled studies. beta-Blockade was evaluated by displacement of the bronchodilator (specific airway conductance), positive chronotropic (heart rate), and tremorogenic (finger tremor amplitude) dose-response curve for inhaled isoproterenol. In study 1, 0.5% betaxolol, 0.6% metipranolol, and 0.5% timolol were tested in 16 subjects. Compared with placebo, all beta-blockers resulted in a significant systemic beta-blockade (p greater than 0.05); the increasing order of potency was betaxolol, metipranolol, and timolol. In study 2, 2% butylamino-phenoxy-propanol-acetate (BPPA; a noncardioselective but topically oculoselective drug) and 1% timolol were investigated in 12 subjects. Placebo and BPPA showed no differences (p greater than 0.05), whereas timolol resulted in a significant beta-blockade (p less than 0.05). Topical oculoselectivity is an important aspect of drug safety of beta-blocking eyedrops. Measure of tremor is appropriate to evaluate beta 2-blockade.
Continuous venovenous hemofiltration in the management of acute decompensation in inborn errors of metabolism. Continuous venovenous hemofiltration was used to treat two neonates, one with maple syrup urine disease and the other with an inborn error of long-chain fatty acid oxidation. The latter infant had hypoglycemia, hyperammonemia and lactic acidosis. In both cases, acceptable biochemical control was achieved within 8 hours. This therapy offers the potential to overcome acute crises rapidly in a wide range of inborn errors of intermediary metabolism.
Immunocytochemical detection of kappa and lambda light chain V region subgroups in human B-cell malignancies. We have used a sensitive immunoperoxidase method and highly specific anti-light chain antisera to determine the light chain variable region (VL) subgroup nature of cytoplasmic (c) and cell surface (s) Ig expressed by human monoclonal plasma cells and B lymphocytes. The immunocytochemical characterization of cIg and sIg used antisera specific for the established kappa light chain V kappa subgroups (V kappa I, V kappa II, V kappa III, and V kappa IV) and the lambda light chain V lambda subgroups (V lambda I, V lambda II/V, V lambda IV, and V lambda VI). Studies were performed using cytospin preparations of bone marrow-, peripheral blood-, and lymph node-derived cells from patients with multiple myeloma, amyloidosis AL, and Waldenstrom's macroglobulinemia and with low-, mid-, and high-grade B-cell malignancies. The V kappa or V lambda subgroup of the cIg or sIg also could be identified after deparaffinization and enzyme treatment of formalin-fixed, paraffin-embedded specimens. For those patients who had monoclonal serum or urinary Igs, there was complete concordance between the VL subgroup of the secreted Ig and that of the cIg or sIg. The percentage distribution of V kappa or V lambda subgroups on the sIg of cells from patients with chronic lymphocytic leukemia (CLL) and other cytomorphologic types of B-cell malignancies differed from that found for kappa- or lambda-type Bence Jones proteins obtained from patients with multiple myeloma, amyloidosis AL, and Waldenstrom's macroglobulinemia. In contrast to the plasma cell and lymphocytoid plasma cell diseases, a relative predominance of certain VL subgroups, ie, V kappa IV, V lambda III, and V lambda IV, and the absence of the amyloid-associated V lambda VI subgroup were found in CLL and related diseases. The immunocytochemical techniques used make possible a rapid means to demonstrate B-cell monoclonality and provide further evidence for the selective expression of certain VL genes in human B-cell neoplasia.
HDL, HDL2, and HDL3 subfractions, and the risk of acute myocardial infarction. A prospective population study in eastern Finnish men. BACKGROUND. We investigated the association of cholesterol concentrations in serum high density lipoprotein (HDL) and its subfractions HDL2 and HDL3 with the risk of acute myocardial infarction in 1,799 randomly selected men 42, 48, 54, or 60 years old. METHODS AND RESULTS. Baseline examinations in the Kuopio Ischaemic Heart Disease Risk Factor Study were done during 1984-1987. In Cox multivariate survival models adjusted for age and examination year, serum HDL cholesterol of less than 1.09 mmol/l (42 mg/dl) was associated with a 3.3-fold risk of acute myocardial infarction (95% confidence intervals [CI], 1.7-6.4), serum HDL2, cholesterol of less than 0.65 mmol/l (25 mg/dl) was associated with a 4.0-fold risk of acute myocardial infarction (95% CI, 1.9-8.3), and serum HDL3 cholesterol of less than 0.40 mmol/l (15 mg/dl) was associated with a 2.0-fold (95% CI, 1.1-4.0) risk of acute myocardial infarction. Adjustments for obesity, ischemic heart disease, other cardiovascular disease, maximal oxygen uptake, systolic blood pressure, antihypertensive medication, serum low density lipoprotein cholesterol, and triglyceride concentrations reduced the excess risks associated with serum HDL, HDL2, and HDL3 cholesterol in the lowest quartiles by 52%, 48%, and 41%, respectively. Additional adjustments for alcohol consumption, cigarettes smoked daily, smoking years, and leisure time energy expenditure reduced these excess risks associated with low HDL, HDL2, and HDL3 cholesterol levels by another 26%, 24% and 21%, respectively. CONCLUSIONS. Our data confirm that both total HDL and HDL2 levels have inverse associations with the risk of acute myocardial infarction and may thus be protective factors in ischemic heart disease, whereas the role of HDL3 remains equivocal.
Calcium metabolism and dietary calcium in salt sensitive hypertension. Evidence has accumulated over the past decade that suggests a relationship between low calcium intake, abnormalities in cation metabolism and hypertension in certain segments of the essential hypertension population. This evidence has been developed from epidemiological data, calcium intervention trials and observations related to biochemical alterations suggestive of a calcium deficiency in certain patients with hypertension and in animal models of essential hypertension. It is becoming increasingly evident that salt sensitive individuals are especially likely to be characterized by abnormalities of calcium metabolism and blood pressure responses to dietary calcium. In this review the role of calcium in the regulation of blood pressure is examined with an emphasis on epidemiological, biochemical, hemodynamic and dietary intervention data in the salt sensitive hypertensive patient.
Epidemiology of acute rheumatic fever in a multiethnic, multiracial urban community: the Miami-Dade County experience. During the mid-1980s, several US communities experienced outbreaks of acute rheumatic fever (ARF), often involving predominantly white, middle-class individuals living in suburban or rural settings. The medical records of all patients diagnosed with ARF in Miami-Dade County, Florida, between 1984 and 1988 were reviewed. Thirty-five cases met the revised Jones criteria and were considered definite; four additional cases were classified as probable. Carditis was present in 54%. Of the 39 patients, 32 (82%) were black. The annual incidence of ARF among black children aged 5-14 years was 12.25 per 100,000 compared to 0.71 for other (non-Hispanic white plus Hispanic) children (P less than .001). ARF was centered in the inner city, where the incidence among black children reached 15.21. Despite the multiethnic, multiracial character of Miami-Dade County and the rapid influx of immigrants, ARF in this community remains primarily a disease of underprivileged, black inner-city children.
Flecainide acetate prevents recurrence of symptomatic paroxysmal supraventricular tachycardia. The Flecainide Supraventricular Tachycardia Study Group Oral flecainide acetate was administered to 34 patients with documented symptomatic paroxysmal supraventricular tachycardia (PSVT) with a double-blind, placebo-controlled, 8-week crossover trial design. PSVT was defined as a regular tachycardia of at least 120 beats/min without evidence of atrioventricular dissociation. The study required considerable patient cooperation. Patients first entered a 4-week qualifying phase followed by a 3-week, open label, flecainide dose-ranging phase. They were then randomized in a blind fashion to receive either placebo or tolerated flecainide dose for an 8-week treatment period and then crossed over after four symptomatic documented episodes of PSVT or at the end of the treatment period. By all efficacy parameters analyzed, flecainide was superior to placebo. Flecainide was associated with an actuarial 79% freedom from symptomatic PSVT events compared with only 15% on placebo at 60 days (p less than 0.001). Of the 34 patients, 29 had recurrence of symptomatic PSVT at least once during the placebo phase; only eight patients had a recurrence during the flecainide phase (p less than 0.001). The median time to the first symptomatic PSVT event was 11 days in the placebo group and greater than 55 days in the flecainide group (p less than 0.001). Likewise, the interval between attacks was a median of 12 days on placebo compared with more than 55 days on flecainide (p less than 0.001). Finally, the flecainide slowed symptomatic PSVT heart rates to 143 +/- 12 beats/min from 178 +/- 12 on placebo (p less than 0.02) in the seven patients who had events in the placebo and flecainide treatment phases.
Pharmacologic therapy for fetal arrhythmias. Although great strides have been made in diagnosing fetal cardiac anatomic and functional abnormalities, in utero cardiac therapy is limited to the treatment of significant arrhythmias. The fetal prognosis may change if the dysrhythmia persists or if the condition results in intrauterine heart failure. When either complication is evident, intrauterine drug therapy may be indicated if the fetus is considered too immature for delivery. Information from case reports has shown several drugs to be useful to cardiovert the fetus, with digitalis being the pharmacologic agent used most often. At present, treatment consists mainly of transplacental administration of antiarrhythmic agents with the object of normalizing FHR and rhythm and abolishing, or preventing, fetal cardiac failure. Various agents have been used with variable success. More direct fetal therapy by intramuscular injection or umbilical vein infusion may replace unsuccessful indirect maternal therapy. It is unclear why some fetuses respond (or appear to respond) and others have hydrops and die in the absence of congenital heart disease or documented infection. With proper therapy, many fetuses survive and have a satisfactory prognosis, depending on the form of arrhythmia and the nature of any cardiac structural defects.
The stratification of cardiac surgical procedures according to use of blood products: a retrospective analysis of 1480 cases. The use of blood products in 1480 consecutive cases of adult cardiac surgical procedures over a period of 15 mth was studied retrospectively using the database of the Department of Anaesthesia of the Institut de Cardiologie de Montreal. Use of blood products was compared in patients having (1) coronary artery bypass grafting, (2) valvular surgery, (3) or a combination of 1 and 2. First operations were compared with reoperations. Overall, the use of homologous blood products was greatest in patients of Group 3, intermediate in patients of Group 2, and smallest in patients of Group 1. Reoperations were associated with an increase in intraoperative transfusion of packed red blood cells, but postoperative chest drainage was similar to first operations. When all blood products (packed red blood cells, fresh frozen plasma and platelets) were taken into consideration, patients undergoing primary CABG or valve surgery were the least exposed to homologous blood donors (five and six units transfused respectively). Repeat CABG was associated with an intermediate exposure to homologous blood products (eight units). Finally, primary and repeat combined procedures, and repeat valve surgery were associated with the greatest exposure to foreign blood products (10, 13 and 10 units respectively). The data presented in this study provide a rational basis for stratification of procedures according to the expected use of blood products, particularly in view of future studies which may be planned to examine the efficiency of blood conservation strategies.
Abnormal blood pressure response to exercise in borderline hypertension. A two year follow-up study. Twenty-eight men with borderline hypertension according to the World Health Organization criteria underwent maximal exercise testing, and then were followed for a two year period. The prevalence of abnormal blood pressure behavior during exercise was 53.58% (n = 15). During follow-up established hypertension developed in 63.33% (n = 10) of subjects with an abnormal blood pressure response to exercise, and only in 15% (n = 2) of subjects with normal blood pressure behavior. In predicting established hypertension development in a two year follow-up, maximal exercise testing has the following statistical values: sensitivity = 83.33%, specificity = 68.75%, accuracy = 75%, positive predictive value = 66.66%, negative predictive value = 84.61%.
Neo-adjuvant (pre-emptive) cisplatin therapy in invasive transitional cell carcinoma of the bladder. Following 2 pilot studies which showed 57 and 61% response rates to intravenous cisplatin for transitional cell carcinoma of the bladder prior to definitive treatment, the West Midlands Urological Research Group (WMURG) and the Australian Bladder Cancer Study Group (ABCSG) independently began randomised trials to test the survival benefit of neo-adjuvant intravenous cisplatin prior to radiotherapy in T2-T4 M0 transitional cell carcinoma of the bladder. Both trials failed to recruit their target numbers of 250 patients in the West Midlands and 320 in Australia. Since they had similar treatment protocols and eligibility criteria, they were combined in an overview analysis, achieving a total number of 255 patients. Each treatment group was compared with its own control group and the differences were pooled to give an overall result. There was no difference in survival between treated and control patients. The odds ratio was 1.13 with the control groups faring marginally better than the chemotherapy groups. Even with 255 patients the 95% confidence interval of the odds ratio was wide (0.80-1.57). Although there is no clear evidence of a clinically worthwhile benefit from neo-adjuvant cisplatin, this approach must be tested in a larger study using combination treatments with greater activity in metastatic disease.
Coronary capillaries in patients with congestive cardiomyopathy or angina pectoris with patent main coronary arteries. Ultrastructural morphometry of endomyocardial biopsy samples. BACKGROUND. The coronary microvasculature may be abnormal even in the presence of angiographically normal epicardial arteries. Abnormalities of small coronary vessels have been invoked as a cause of angina. METHODS AND RESULTS. To quantitatively evaluate the morphology of capillaries in patients with idiopathic dilated cardiomyopathy (DCM) or the syndrome of angina and small vessel disease (SVD), we performed electron microscopic morphometry of capillaries in right ventricular biopsy samples taken from 32 patients. Ten had angina, normal epicardial coronary arteries, and evidence for SVD; 12 had DCM; and 10 had normal hearts. In patients with DCM, the ratio of microvessels to myocytes was not different than that of controls (0.49 +/- 0.06 versus 0.51 +/- 0.05). Mean cross-sectional areas of the capillaries (lumen plus wall) and lumen were significantly greater than those of controls (45.3 +/- 15.1 versus 22.7 +/- 8.3 micron 2, p less than 0.001; 17.6 +/- 6.9 versus 11.6 +/- 6.2 micron 2, p less than 0.05, respectively). Fibrous content of the myocardium, as assessed by quantitative light microscopy, was significantly increased (16.3 +/- 3.3% versus 5.0 +/- 2.4%, p less than 0.001). In contrast, in patients with SVD, the capillary-to-myocyte ratio was reduced (0.33 +/- 0.08, p less than 0.001). Although mean cross-sectional areas of the entire capillary (32.4 +/- 19.7 micron 2) and the lumen (8.9 +/- 7.8 micron 2) were not statistically different than those of controls, there was an absence of capillaries less than 15 micron 2 in cross-sectional area, and the frequency distribution of the lumen area was skewed to the left. Swollen endothelial cells frequently encroached upon the lumen. There was a mild increase in fibrous content (9.5 +/- 3.7%, p less than 0.05). CONCLUSIONS. Enlarged capillaries and a normal ratio of capillaries to myocytes appear to be features of DCM. Of the patients with SVD, there was both a relative lack of capillaries and capillary lumen narrowing from swollen endothelium. These changes may induce ischemia and angina and may result in mild fibrosis.