shukoor65/lab-rag-model huggingface dataset:
Sodium regulation in the affinity of renal alpha 2-adrenoceptors for epinephrine in Sabra salt-sensitive and salt-resistant rats. Sodium ions markedly decreased in vitro renal alpha 2-adrenoceptor affinity for epinephrine in Sabra hypertensive (SBH) but not in normotensive (SBN) rats. Under these conditions, affinity of alpha 1-adrenoceptor for epinephrine was unchanged in SBH and SBN rats. If these data could be confirmed in vivo, the sodium ion, by acting as an inhibitor, could modify the effect of agonists on renal alpha 2-adrenoceptors in SBH rats. Conversely, the absence of sodium regulation in SBN rats might represent a genetically mediated change responsible for the resistance to the development of salt-induced hypertension.
Collagenous colitis with involvement of terminal ileum. We present a case of collagenous colitis with evidence of terminal ileal involvement. The patient suffered from chronic watery diarrhea of three months' duration, and colonoscopy revealed a normal endoscopic appearance. Histologic examination of biopsies revealed a broad subepithelial band of collagen, with similar histologic findings in the terminal ileum. Additionally, the patient exhibited abnormalities of d-xylose and vitamin B12 absorption, although there were no clinical signs of malabsorption. Biopsy of the proximal small intestine was normal. The significance of these findings for the definition of the clinicopathologic entity of collagenous colitis and its pathogenesis are discussed.
Realistic expectations for the patient with intermittent claudication. To determine the natural history of intermittent claudication 112 patients were followed for a minimum of 5 years and a median period of 82 months. Thirty-seven patients (33 per cent) died during the study period. Myocardial infarction (44 per cent) and cerebrovascular disease (28 per cent) were the most common causes of death. Overall mortality rate was 8, 23 and 40 per cent, at 2, 5 and 8 years respectively. Initial ankle-brachial pressure index (ABPI) correlated with subsequent death. With an initial ABPI less than 0.5 death occurred in 20, 50 and 69 per cent at 2, 5 and 7 years respectively, compared with 5, 16 and 24 per cent respectively for those with an initial ABPI greater than or equal to 0.5 (P less than 0.0001). Of the survivors only 21 per cent had worsening claudication and 13 per cent progressed to critical ischaemia. Arterial bypass for limb salvage was required in eight patients and four limbs were lost during the study period. ABPI identifies a subgroup of claudicants with an extremely high risk of death from coronary and/or cerebral pathology. In this subgroup an aggressive approach to the correction of atherosclerotic risk factors, rather than emphasis on the peripheral vascular problem alone, may improve survival.
Management of the failed exstrophy closure. In the last 5 years we have seen 15 boys and 9 girls with failure of exstrophy closure, including 20 who had classical bladder exstrophy and 4 who had cloacal exstrophy. At the time of presentation 18 patients had undergone 1 closure while 6 patients had undergone 2 prior exstrophy closures. Closure was performed for complete bladder dehiscence in 16 cases and for significant bladder prolapse in 8. None of the patients underwent any form of osteotomy at the time of initial closure and in 19 closure was done within 72 hours of birth. Two patients underwent posterior iliac osteotomy elsewhere at the time of secondary closure. All patients referred to our institution underwent either posterior iliac osteotomy (8 patients) or anterior innominate osteotomy (16 patients). Epispadias repair along with reclosure of bladder exstrophy was done in 13 boys. The upper tract remained normal in all patients. There were no instances of failure in this group of reclosures. Eight patients have undergone subsequent bladder neck reconstruction of whom 7 are dry for 4 hours and 1 remains totally incontinent. Two patients have undergone simultaneous bladder neck reconstruction and augmentation cystoplasty, and they are dry on intermittent self-catheterization. The failed exstrophy closure presents a formidable dilemma. However, a secure reclosure can be achieved with careful surgical technique, a well performed osteotomy (even if previously performed) and concomitant epispadias repair for male subjects.
A comparative analysis of Giliberty, Bateman, and Universal femoral head prostheses. A long-term follow-up evaluation. This study compares four different types of bipolar hip prostheses used from 1977 to 1984. The devices studied were the Giliberty I and II hip prostheses, the Bateman I prosthesis, and the Universal Hip Replacement (UHR) prosthesis. The surgical indications for prosthetic hip replacement in all cases were displaced subcapital hip fractures (Garden Types 3 and 4). Postoperative evaluation included D'Aubigne's hip rating system and roentgenograms to assess prosthetic placement, dislocation, disassembly of the components, and the presence of inner and outer bearing motion of the prostheses. Results of the study revealed intact inner bearing motion in all of the devices investigated in the immediate postoperative period. The UHR prosthesis demonstrated a statistically significant lower incidence of dislocation and no incidence of prosthesis disassembly. This study demonstrates the superiority of the bipolar prosthesis when compared to published results of the so-called unipolar prosthesis and also suggests superiority of the design and function of the UHR prosthesis when compared to the Bateman I and Giliberty prostheses. Longer follow-up evaluation is needed to assess the effects of a functioning bipolar prosthesis on acetabular wear.
Preventive practices for adult cardiovascular disease in children. BACKGROUND. Differences between family practitioners and pediatricians regarding appropriate interventions for cardiovascular disease prevention in pediatric patients have been described by national surveys of physicians in the two specialties. the purpose of the study reported here was to determine whether similar differences existed in a more complete sample from a confined geographical area in which local standards of care might influence physicians practicing in the locale. METHODS. Members of the Southwestern Ohio Society of Family Physicians and the Cincinnati Pediatric Society were surveyed by questionnaire about their attitudes and practices concerning cardiovascular risk factors in children. The response rate was greater than 70% in each specialty group. RESULTS. Differences in the diagnosis and treatment of hypercholesterolemia were detected: (1) pediatricians screened patients at younger ages and used lower cutoff points for diagnosis (5.0 vs 5.5 mmol/L [192 vs 211 mg/dL]); and (2) family physicians were more likely to treat with medication (57% vs 5%), whereas pediatricians referred hypercholesterolemic patients to specialists more often (71% vs 19%). Both family physicians and pediatricians mislabeled blood pressures at the age-specific 90th percentile as normal (21% and 14%, respectively); this occurred more commonly with younger patients. Blood pressure was the risk factor most often measured, but smoking was the risk factor that received the most counseling by physicians in both specialties. CONCLUSIONS. Both family physicians and pediatricians reported feeling inadequately prepared to counsel lifestyle changes, and ranked obesity, smoking, and cholesterol as topics of greatest interest for continuing medical education courses. Physicians in both specialties did not routinely update family history of cardiovascular disease during well-child visits.
Prevention of cerebral vasospasm by actinomycin D. The role of endothelin, a newly found vasoconstrictor peptide, is examined in the pathogenesis of cerebral vasospasm after experimental subarachnoid hemorrhage (SAH) in the dog. Endothelin immunoreactivity was overexpressed in the endothelium of the vasospastic basilar artery. Because endothelin synthesis is regulated at the messenger ribonucleic acid transcription level, the effect of actinomycin D, a ribonucleic acid synthesis inhibitor, was studied as a means of preventing vasospasm. It was found that treatment with intravenous actinomycin D for 5 days beginning on the day of SAH completely inhibited the development of vasospasm. This novel experimental therapy may lead not only to the elucidation of the pathogenesis of cerebral vasospasm but also to the availability of a prophylactic adjuvant therapy for patients with SAH.
Cardiovascular and antiarrhythmic effects of esmolol in children. This prospective study evaluated the cardiovascular and antiarrhythmic effects of esmolol, an intravenous beta-blocker with an extremely short half-life. Twenty patients (aged 2 to 16 years) underwent diagnostic electrophysiologic studies at rest and during beta-blockade induced with esmolol. An initial dose of 600 micrograms/kg was infused for 2 minutes and followed by an infusion of 200 micrograms/kg per minute. The dosage was increased by 50 to 100 micrograms/kg per minute every 5 to 10 minutes until a reduction of greater than 10% in either heart rate or mean blood pressure was seen. The dosage required to achieve beta-blockade ranged from 300 to 1000 micrograms/kg per minute (mean 550 micrograms/kg per minute). Electrophysiologic effects included a decrease in the rate of sinoatrial node discharge and delay in conduction through the atrioventricular node. There was no effect on His-Purkinje conduction. Atrial and ventricular effective refractory periods were unchanged. In six patients with supraventricular tachycardia, esmolol prevented induction of tachycardia in four and slowed the rate of the tachycardia in two. In four patients with ventricular tachycardia, clinical findings were improved in three and unchanged in one. Heart rate and blood pressure returned to near baseline values 10 minutes after the esmolol infusion was stopped. Adverse ventricular electrophysiologic effects were observed in two patients with biopsy evidence of myocarditis. No other adverse effects were seen. We conclude that the effects of esmolol in children are similar to those of other beta-blockers and that it is useful in the evaluation and management of pediatric tachyarrhythmias. The weight-adjusted dosage required to induce beta-blockade in children is larger than the adult dosage, and the effects of esmolol dissipate rapidly.
Radical hysterectomy with lymphadenectomy for treatment of early stage cervical cancer: clinical experience of 278 cases. This study includes 278 cases of stage I and II cervical cancer subjected to radical hysterectomy and lymphadenectomy. The clinical experience of 278 cases is reviewed. Of these cases, 215 were in stage I, and 63 were in stage II. Intraoperative complications occurred at a rate of 9.7% and involved injuries to the great vessels, lower urinary tract, nerves, and rectum. Operative mortality was found to be 0.3%. Postoperative complications were observed in 20.1% of patients. Fistulae were observed in 8 (2.8%) patients. The overall survival rate was 83.8%. The 5-year survival rates for stages IA, IB, IIA, and IIB were 100.0%, 87.9%, 71.0%, and 64.0%, respectively. Pelvic lymph node metastases varied from 0% for stage IA to 40.0% for stage IIB and paraaortic involvement varied from 0% for stage IA to 50.0% for stage IIB. Radical surgery seems to be the treatment of choice for patients with early invasive cervical cancer.
Somatosensory and magnetic evoked potentials in a postoperative paraparetic patient: case report. Somatosensory evoked potential (SSEP) testing is increasingly being used to test for spinal cord injuries and to monitor spinal surgery to reduce the risk of paraplegia. It is a sensory test, but it is assumed that any process severe enough to affect the motor tracts will also affect the sensory tracts and, therefore, be identified. Increasingly, however, isolated motor-tract involvement has been reported. A new technique, magnetic coil stimulation of the cortex, directly monitors the motor tracts. We report a case where the SSEP was normal although the magnetic motor-evoked potential was abnormal, supporting the hypothesis that direct testing of motor tracts may be advantageous.
Partial agenesis of the anterior corpus callosum: correlation between appearance, imaging, and neuropathology. Two patients with partial (semilobar) holotelencephaly are reported with apparent partial agenesis of the corpora callosa. These patients are of interest because they appear to possess the posterior portion of the corpus callosum but not its anterior component. Because the corpus callosum develops in the commissural plate rostrally and is elaborated in a rostral-caudal gradient, this apparent lack of the rostral component is embryologically puzzling. The neuropathologic studies of 1 patient resolved the apparent discrepancy between magnetic resonance imaging and embryology of the corpus callosum. With these data, we addressed the embryologic factors that may explain this malformation.
Obstetric accidents: the patient's perspective. Cases from the files of Action for Victims of Medical Accidents which had resulted in stillbirth, perinatal or neonatal death and long term mental or physical handicap were reviewed. In 41 cases there was both a detailed letter from the parents and an independent review by a senior obstetrician. The reviewer's main criticisms were of inadequate fetal heart monitoring, lack of involvement of senior staff and inadequate records. The fetal heart trace was missing in 7 cases and over half of the remaining 34 traces available were misinterpreted or not acted on. In 17 cases junior doctors failed to recognize fetal distress and managed a delivery that they did not have the experience to deal with. In a further 6 cases, senior staff were called but did not come. Records were criticized for being incomplete, illegible or missing. In a few cases unjustified alterations appeared to have been made. Women reported that on some occasions staff ignored their worries, were unsympathetic and gave too little information. Some parents also experienced considerable difficulty in obtaining a clear explanation of the nature and cause of their child's condition.
Effect of dietary menhaden oil on normal growth and development and on ameliorating mucosal injury in rats. We evaluated the effects of menhaden oil on growth and development of the small intestinal mucosa in growing rats and on the progression and resolution of methotrexate-induced mucosal injury in the rats. One study compared effects of diets containing 10% safflower oil(SO), 9% SO and 1% menhaden oil (MO), 10% MO, or 9% MO and 1% SO on mucosal growth and development for 125 d. In another study, animals fed the 10% MO or the 10% SO diet for 5 wk were subjected to subcutaneous methotrexate injections for 3 consecutive days. Feeding rats a diet containing large amounts of menhaden oil resulted in lower prostaglandin E2 and leukotriene B4 synthesis and lower sucrase activities. Indicators of mucosal mass after methotrexate-induced injury were significantly improved in both the jejunum and ileum at 3 and 10 d after methotrexate administration. Our data suggest that dietary menhaden oil stimulates mucosal regeneration after methotrexate-induced injury.
Surgical collars: a survey of their prescription and use. We report the results of a questionnaire survey of 124 orthopaedic, rheumatology, medical and accident and emergency outpatients prescribed a surgical collar during a 3-month period. Of these, 99 (80%) returned the questionnaire. Instructions received about when to wear the collar differed widely, especially between specialties. Most patients (76%) found benefit in wearing the collar. Pain was the symptom helped most (78%) whilst dizziness was helped least (40%). Problems with the collars were common, many being too hot (69%) and uncomfortable (48%). A third had difficulty putting the collar on. Despite these problems, compliance was good with 19 patients discontinuing collars for reasons other than recovery or medical advice. We believe this study highlights further areas for research and stimulates a re-evaluation of collar usage.
Usefulness of severity of myocardial ischemia on exercise testing in predicting the severity of myocardial ischemia during daily activities. To determine the relation between myocardial ischemic indexes on exercise testing and on ambulatory Holter recording, 60 patients with stable coronary artery disease who exhibited an ischemic response to both testing procedures were studied. All patients performed a Bruce protocol exercise test and underwent 24-hour Holter recording within 2 weeks without antianginal medications. Mean exercise duration was 7.4 +/- 2.8 minutes, mean heart rate at 1-mm ST depression was 118 +/- 20 beats/min and mean maximal ST depression during exercise was 2.2 +/- 1 mm. During Holter recording the average number of ischemic episodes was 4.7 +/- 2.6 per patient, mean duration of daily ischemia was 62 +/- 54 minutes, mean maximal ST depression was 3.2 +/- 1.3 mm and average heart rate at 1-mm ST depression was 93 +/- 17 beats/min. Overall, the correlations between ischemic indexes on both testing procedures were very weak (mean r2 = 0.054). The only exercise variable that had a significant correlation (p less than 0.05) with all Holter variables was heart rate at 1-mm ST depression, yet it correlated very weakly (0.064 less than or equal to r2 less than or equal to 0.125) with most Holter covariates and had a better correlation (r2 = 0.256) only with average heart rate at 1-mm ST depression during Holter. Thus, ischemic indexes on exercise testing cannot accurately predict ischemic indexes on ambulatory Holter recording in patients with stable coronary artery disease who exhibit ischemic changes on both tests.
A molecular genetic study of factor XI deficiency. Factor XI deficiency is a rare bleeding diathesis found predominantly in Ashkenazi Jewish kindreds. A recent study of six Jewish patients identified three distinct mutations (Types I, II, and III) in the factor XI gene that were sufficient to fully define the genotypes of the patients. We have investigated 63 patients with factor XI deficiency and find overall allele frequencies of 44% for the type II mutation, 31% for the type III mutation, and 0% for the type I mutation. Therefore, 25% of the mutant factor XI alleles in our sample remain undefined. However, the distribution of mutant alleles is significantly different between Jewish and non-Jewish populations with hitherto undefined mutations accounting for 84% of the disease alleles in non-Jewish patients. Plasma factor XI:C levels were found to differ significantly between different homozygous and compound heterozygous genotypes and the inheritance of the II/III genotype was found to carry an increased risk of the most severe bleeding tendency.
Surgical treatment and prevention of vasculopathic impotence in conjunction with revascularisation of the lower extremities in Leriche's syndrome. The results are presented of combined revascularization of the lower extremities and the penis in 29 patients with Leriche's syndrome. This was effected by placing an autogenous venous shunt between the branch of a prosthesis or the common femoral artery and one of the dorsal arteries of the penis. Preoperatively lost sexual function was restored in 6 patients, while in 16 the sexual function was maintained at the preoperative level or improved in the late postoperative period. A comparison of the results obtained with the sexual performance of patients who had undergone bifurcated aortofemoral shunting only, prompted the conclusion that this surgical procedure was effective in the prevention and treatment of vasculopathic impotence in Leriche's syndrome.
Life-sustaining therapy. A model for appropriate use New strategies are needed to curb the proliferation of life-sustaining therapies that rarely benefit patients. We propose a model for appropriate use of such therapies that incorporates effectiveness, utility, and marginal costs. If a therapy is rarely effective and rarely desirable, it is considered medically inappropriate. If the marginal cost-effectiveness ratio is inordinately high, it is considered economically inappropriate. If a therapy is either medically or economically inappropriate, it should not be automatically offered. The model provides an operational definition of futility and is illustrated with an analysis of out-of-hospital cardiopulmonary resuscitation for chronically ill older people. Advance directives, explicit health care rationing, and defining futile therapy based on survival predictions are alternatives to the appropriate care model, but are insufficient strategies to solve the problem of inappropriate life-sustaining care.
Binding of kidney bean (Phaseolus vulgaris) isolectins to differentiated human colon carcinoma Caco-2 cells and their effect on cellular metabolism. The binding of Phaseolus vulgaris (PHA) isolectins L4 and E4 to the brush border membrane of differentiated Caco-2 cells was studied and the impact on cellular metabolism and microvilli was assessed. Computer analysis of the data based on binding experiments with peroxidase conjugated isolectins gave mean (SD) values for maximal binding of 2540 (151).10(-9) M for PHA-L4 and 2104 (140).10(-9) M for PHA-E4 per mg of brush border membrane protein. The dissociation constants for L4 and E4 binding were 4.3 (1.4).10(-6) M and 1.1 (0.8).10(-6) M, respectively. Incubation of differentiated Caco-2 cells for 30 minutes with ferritin conjugated PHA isolectins showed that, as indicated by the number of ferritin particles, PHA-E4 bound to the microvilli to a greater extent than PHA-L4. Ferritin particles were also localised intracellularly over endocytotic invaginations and vesicles. After incubation for 48 hours with PHA-L4 or PHA-E4, the relative incorporation of precursors for DNA, RNA, and (glyco)protein synthesis into the trichloroacetic acid insoluble fraction of the Caco-2 cells was determined. Both isolectins stimulated the incorporation of thymidine and glucosamine, but neither PHA-L4 nor PHA-E4 were able to influence the incorporation of uridine. With respect to fucose, methionine, and N-acetyl mannosamine, the stimulatory effect remained confined to PHA-E4. Since PHA-L4 and PHA-E4 were tested at the same concentrations, PHA-E4 is more effective than PHA-L4. The changes in the uptake of radioactive precursors were lost after heat inactivation of PHA-E4. Compared with control and PHA-L4 incubated Caco-2 cells, the microvilli of PHA-E4 incubated cells were shortened significantly (p less than 0.01).
Linear lupus erythematosus profundus in a child. A 9-year-old Japanese boy had a 6-year history of a linear eruption of the left leg. It was characterized histopathologically by an intense lymphocytic panniculitis, perivascular and periappendageal infiltrates of lymphocytes, and vacuolization of the basal cell layer. This case represents a clinical presentation of linear lupus erythematosus profundus not previously reported.
Transureteroureterostomy with cutaneous ureterostomy: a 25-year experience. We reviewed 67 patients who underwent transureteroureterostomy with cutaneous ureterostomy for benign (32) and malignant (35) disease in regard to the indications for and complications of the procedure. The most common complications included urine leakage at the ureteroureterostomy, stomal stenosis and calculus formation. Renal function improved or remained stable in 75% of the patients. Transureteroureterostomy with cutaneous ureterostomy is a viable alternative diversion technique in a select group of patients.