shukoor65/lab-rag-model huggingface dataset:
The malignant nature of papillary and cystic neoplasm of the pancreas. Two new cases of papillary and cystic neoplasm of the pancreas are reported. One patient was a 20-year-old woman with massive unresectable liver metastases, and the other was a 15-year-old boy. To study the natural history and malignant potential of this tumor, the English literature was reviewed to obtain an additional 56 cases. Clinical characteristics include pain and a mass in most patients, although many are found incidentally. Jaundice, hemoperitoneum, nausea, and vomiting are unusual findings. Most patients are treated by wide resection with good results. These tumors appear to be indolent. However, 16% of patients had major organ or blood vessel invasion, and 7% had liver metastases at some time during the course of their disease, illustrating the malignant nature of this tumor. Long-term follow-up is necessary to evaluate the efficacy of treatment, especially in the case of locally advanced and metastatic disease.
Hepatic fibrosis and cirrhosis after chronic administration of alcohol and "low-dose" carbon tetrachloride vapor in the rat Rats were exposed to carbon tetrachloride vapor, 5 days/wk, 6 hr/day, for periods of 5 or 10 wk at a concentration that by itself caused only fatty change with minimal liver cell necrosis and no fibrosis. The same carbon tetrachloride exposure when given in association with chronic alcohol feeding resulted in extensive hepatic fibrosis at 5 wk and established micronodular cirrhosis at 10 wk. The periodicity of the exposure profile was chosen to simulate that of human exposure to environmental toxins, albeit at a higher dose than would be permitted in the workplace. The development of significant liver injury in this animal model raises the possibility that some chronic liver injury in humans may be due to alcohol potentiation of other hepatotoxins present in the environment at subtoxic levels.
Osteogenic sarcoma of the head and neck. The UCLA experience. Eighteen cases of osteogenic sarcoma of the head and neck were treated at our institution between 1955 and 1987. The patients' ages ranged from 5 to 73 years, with a median age of 28 years. The sex distribution was equal. Follow-up ranged from 1 to 276 months, with a median of 79 months. The primary site of the tumor was the mandible in nine cases, maxilla and paranasal sinuses in six, skull in two, and orbit in one. Six of 18 patients were free of disease with greater than 5 years of follow-up. Four of the six received combined surgery, radiation therapy, and chemotherapy as their primary treatment. Of the five patients treated with surgery alone, four suffered recurrences, one of whom was salvaged with further surgery and chemotherapy. Five patients were treated initially without surgery. They received radiation therapy with or without chemotherapy; all five developed local recurrence. We conclude that osteogenic sarcoma of the head and neck is an aggressive tumor, prone to both local and distant failure. Based on our series and from published experience involving the extremities, osteogenic sarcoma of the head and neck should be managed with multimodality therapy.
Zones of differential sensory block during extradural anaesthesia. We have measured spinal segmental levels of anaesthesia to light touch (LT), pinprick (PP) and cold temperature discrimination (TE) during 2% lignocaine extradural anaesthesia in 22 patients, to determine if zones of differential sensory block develop during extradural anaesthesia and, if so, the extent to which TE extends beyond PP or LT levels and how age affects differential block. The median thoracic dermatomal levels were 4.5 for LT, 2.0 for PP and 2.0 for TE. Zones of differential sensory block developed within 5 min of extradural injection of local anaesthetic, and persisted for the next 55 min. In all instances, PP extended more cephalad than LT, and TE extended above PP levels. There were no differences in the extent of zones between the two groups of patients with mean ages of 28 and 48 yr. Thus, during extradural anaesthesia, sympathetic denervation extended one to two spinal segments above the sensory levels of LT and PP anaesthesia, age (28 vs 48 yr) affected neither the cephalad extent nor the width of zones of differential block, and PP levels of anaesthesia were closer to presumed levels of sympathetic block than were LT levels.
Endourology of lower urinary tract. Two methods for obtaining percutaneous access to the bladder are described. Depending on whether or not urethral access is available an endoscopic or fluoroscopic technique may be applied. We have successfully performed suprapubic percutaneous cystolitholapaxy, antegrade fulguration of posterior urethral valves, antegrade cystourethroscopy as an adjunct for urethroplasty, and internal drainage of a bulbar urethral abscess. Endourologic techniques may be readily applied to the lower urinary tract and may be specifically indicated in certain situations.
Time-motion reconstruction of mitral leaflet motion from two-dimensional echocardiography in mitral valve prolapse. To assess the contributions of mitral leaflet billowing and exaggerated systolic mitral anular expansion to posterior motion of mitral leaflets recognized as mitral valve prolapse (MVP) by M-mode echocardiography, time-motion reconstructions of the anteroposterior displacement of points equally spaced along the anterior and posterior mitral leaflets were derived by computer-assisted analysis of 2-dimensional echocardiograms. Late or holosystolic posterior displacement of mitral leaflets, greater than or equal to 2 mm, occurred in the reconstructions from 24 of 24 (100%) patients with MVP with leaflet billowing and in 20 of 24 (83%) patients with MVP without leaflet billowing compared with 4 of 35 (11%) age-sex matched normal adults (both p less than 0.0000002). Posterior motion of the posterior mitral leaflet in time-motion reconstruction was significantly less with respect to the posterior end of the mitral anulus than with respect to the chest wall in patients with nonbillowing MVP (1.6 +/- 1.9 vs 2.7 +/- 1.6, p less than 0.02), but not in those with leaflet billowing (3.6 +/- 1.8 vs 3.9 +/- 1.8, p = not significant), because anular expansion contributed importantly to MVP in the former but not in the latter group. Thus, M-mode echocardiographic patterns of MVP reflect the separate but interacting effects of distinct abnormalities of mitral anular and leaflet dynamics.
Polymorphous low grade adenocarcinoma of the palate in a child. We report a case of polymorphous low grade adenocarcinoma involving the palate of a 12-year-old girl, the first example of this tumour occurring in the paediatric age group. The tumour displayed infiltrative growth, neural invasion, variegated histological patterns, and minimal cytological atypia. The patient remained disease-free four years after wide local excision of the tumour. The distinction of polymorphous low grade adenocarcinoma from pleomorphic adenoma and adenoid cystic carcinoma is also discussed.
Experimental pain thresholds and plasma beta-endorphin levels during exercise. Experimental pain thresholds (electrical intracutaneous finger and dental pulp stimulation) and plasma hormone levels (beta-endorphin, cortisol, and catecholamines) were measured in ten healthy sportive men before, during, and after progressively more strenuous physical exercise. In a double-blind study conducted on two different days, 20 mg of the opioid-antagonist naloxone or placebo was administered prior to exercise. A significant pain threshold elevation was found during exercise for finger (ANOVA, P less than 0.004) and dental pulp stimulation (P less than 0.01). Pain threshold elevation was most pronounced during maximal exertion, at which time the subjects reported the greatest subjective fatigue. Thresholds remained elevated 10-15 min after the end of exercise, and, 60 min after exercise, thresholds returned to baseline values. The subjective magnitude estimation of suprathreshold stimuli was significantly reduced (P less than 0.0001) 5-10 min after exercise. Plasma beta-endorphin, cortisol, and catecholamines increased significantly (P less than 0.0005, all values) during exercise. Plasma beta-endorphin levels did not correlate significantly with pain thresholds (r = -0.37, NS). Naloxone failed to affect pain thresholds, although beta-endorphin and cortisol increased significantly more (P less than 0.02) during exercise after naloxone. It is concluded that short-term, exhaustive physical exercise can evoke a transient elevation in pain thresholds. This exercise-induced elevation in pain threshold does not, however, appear to be directly related to plasma endorphin levels.
Arteriopathy and coarctation of the abdominal aorta in children with mucopolysaccharidosis: imaging findings. Eight children with mucopolysaccharidosis I (MPS I), representing 33% of all children with MPS I seen at our institution during an 18-year period, developed hypertension. Five of these hypertensive children also exhibited symptoms of aortic coarctation. The radiographic evaluation of four of these children with MPS I (three with Hurler syndrome, MPS I H, and one with Scheie disease, MPS I S) and arteriopathy affecting the thoracic aorta, abdominal aorta, and visceral and renal arteries is presented. Hypertension developed in all four children before they were 4 years old; three had differences between upper- and lower-extremity blood pressures. Irregular narrowing of the abdominal aorta with either multiple minor asymmetric wall lesions (n = 2) or abrupt concentric narrowing (n = 2) was present in all children as shown by aortography (n = 3), sonography (n = 3), MR imaging (n = 2), and/or autopsy (n = 1). A variety of other vessels also were involved, including the ascending aorta (n = 1) and vertebral (n = 1), axillary (n = 1), intercostal (n = 2), lumbar (n = 2), mesenteric (n = 3), renal (n = 2), and iliac arteries (n = 3). Autopsy in one child demonstrated thickened heart valves, narrowing of the coronary arteries, and irregularity of the aorta due to deposition of mucopolysaccharide material within the intima. Our series demonstrates various facets of the arteriopathy of MPS I as shown by sonography, MR imaging, and angiography.
Factors associated with poor visual outcome in acute retinal necrosis. We reviewed 22 consecutive patients (26 eyes) with acute retinal necrosis to elucidate whether there was any sign at an early stage to predict poor visual outcome. Final visual acuity of the patients fell into two groups, one worse than 20/600 (15 eyes) and the other better than 20/30 (11 eyes). The patients with poor visual outcome showed diffuse retinal arteritis or arterial obliteration which was associated with reduced amplitude of electroretinographic a and b waves and elevated levels of circulating immune complex, even at an early stage when retinal exudates were still localised to the peripheral fundus. The retinal exudates in these patients extended rapidly to the posterior pole. In contrast, the patients with good visual outcome showed retinal arteritis limited within retinal exudates throughout the course. These signs at an early stage can be used as prognostic factors to manage patients with acute retinal necrosis more constructively.
Behavioral aspects of temperature-taking. Ear thermometry addresses two basic psychological aspects of fevers. The first one is obvious: the battle of the rectal temperature can be eliminated by ear thermometry. The second one addresses the overtreatment of tactile fevers. Tactile temperature taken by feeling the forehead occurs in 50% to 90% of homes. Half of warm foreheads occur in afebrile children who are warm because they're releasing heat generated by a recent activity or bath. If an actual temperature were measured, these children wouldn't be mislabeled as having fever and unnecessarily treated.
Hemodynamic effects of celiprolol in essential hypertension. The immediate and short-term (2 week) hemodynamic and humoral effects of the beta-1 antagonist, beta-2 agonist, celiprolol, were compared with those of more prolonged atenolol therapy in 12 patients with essential hypertension. Celiprolol produced an immediate dose-dependent decrease in mean arterial pressure (113 +/- 3 to 102 +/- 2 mm Hg; p less than 0.001) and total peripheral resistance (49 +/- 3 to 38 +/- 1 U/m2; p less than 0.005) that was associated with an increased heart rate (67 +/- 1 to 73 +/- 2 beats/min; p less than 0.01) and cardiac index (2,347 +/- 129 to 2,708 +/- 111 ml/min/m2; p less than 0.01). Both celiprolol and atenolol reduced mean arterial pressure with short-term treatment (p less than 0.01); this was associated with a reduced total peripheral resistance with celiprolol (from 24 +/- 1 to 21 +/- 1 U/m2; p less than 0.02) and was not observed with atenolol. Moreover, in contrast with atenolol, celiprolol did not change heart rate or stroke and cardiac indexes. Splanchnic and forearm vascular resistances decreased with celiprolol (p less than 0.05) but not with atenolol; neither beta-blocking drug altered renal blood flow. These results demonstrate that the hemodynamic effects of celiprolol were strikingly different from atenolol; celiprolol reduced arterial pressure and total peripheral and certain vascular resistances without altering heart rate, cardiac index or regional blood flows. These effects may be explained by celiprolol's cardiac beta-1 receptor inhibitory and peripheral beta-2 receptor agonistic effects.
Ventricular arrhythmias during treatment with alteplase (recombinant tissue plasminogen activator) in suspected acute myocardial infarction. Continuous electrocardiography during the first 24 hours of a stay in a coronary care unit was used to record ventricular arrhythmias during treatment with alteplase (recombinant tissue plasminogen activator) or placebo. Recordings were made on 378 of the 436 patients admitted to a double blind trial of alteplase or placebo in one participating centre of the Anglo-Scandinavian study of early thrombosis (ASSET), patients being selected according to the availability of recorders. Of these, 309 (158 given alteplase and 151 placebo) had greater than 5 hours of analysable data. Most of the arrhythmias were recorded in patients with an in hospital diagnosis of myocardial infarction. Ventricular couplets and ventricular tachycardia were significantly more common in the patients treated with alteplase. Further, in patients with myocardial infarction who had ventricular extrasystoles, couplets, or ventricular tachycardia type a, the number of hours in which each arrhythmia was recorded was significantly higher in the alteplase group. The various ventricular arrhythmias in the alteplase group tended to cluster in the first 4-12 hours of the recordings. During the first 24 hours admission there were four episodes of ventricular fibrillation in the alteplase group and five in the placebo group of taped patients. By one month there had been 18 deaths in these 309 patients (alteplase four, placebo 14). These bore no relation to any recorded arrhythmia. Clinical records for the patients with no or minimal tape data yielded six further episodes of ventricular fibrillation during the first 24 hours (three in the alteplase group and three in the placebo group).
Multivariate assessment of traditional risk factors for chronic lung disease in very low birth weight neonates. The Newborn Lung Project. All neonates (n = 581) with birth weights less than 1501 gm admitted to seven neonatal intensive care units in Wisconsin and Iowa were candidates for a study aimed at the multivariate assessment of risk factors for chronic lung disease while controlling for baseline severity of respiratory disease. Data from 361 neonates were analyzed for all risk factors except fluids; only neonates weighing less than 1200 gm were included (n = 220). Information on traditional risk factors for chronic lung disease was abstracted. A total of 110 (30%) of the analyzed neonates were oxygen dependent on day 30 of life. The following baseline factors were associated with increased risk of oxygen dependence in a joint multivariate model: lower birth weight (odds ratio 1.4/100 gm), higher baseline severity score (odds ratio 2.7/doubling at 32 weeks gestational age), lower gestational age (odds ratio 2.4/week at severity 0), Apgar score at 1 minute (odds ratio 1.6/2 points), male gender (odds ratio 1.9), and nonblack race (odds ratio 2.2). After adjustment for all baseline factors, patent ductus arteriosus, ventilator pressure at 96 hours, oxygen at 96 hours, and fluid intake were associated with oxygen dependence. Neonates with a low baseline severity score who remained oxygen dependent had a higher intake of fluid relative to output, whereas neonates with a higher baseline severity score had higher fluid intake and output. Lack of weight loss was associated with increased severity but not with oxygen dependence. The results of this study generally confirm the significance of previously reported risk factors for chronic lung disease in a multivariate setting but show that risk factors may not have the same impact in neonates with different baseline severity.
MR imaging of the seminal vesicles. MR imaging (0.35 and 1.50 T) was used to assess the appearance of the seminal vesicles. The size and signal intensity of normal seminal vesicles vary with the age of the subject. In general, on T2-weighted images, the signal intensity of normal seminal vesicles is lower than that of fat in prepubertal children, similar to or higher than that of fat in adults, and similar to or lower than that of fat in patients older than 70 years of age. Endocrine and radiation therapy will influence the size and signal intensity of the seminal vesicles. The purpose of the essay is to illustrate the spectrum of seminal vesicle disease, including congenital anomalies, inflammation, and neoplastic disease. Although MR imaging is helpful in depicting seminal vesicle abnormalities, it does not allow differentiation of benign from malignant disease, distinction of hemorrhage due to tumor invasion from postbiopsy changes, or distinguishing between glandular obstruction due to tumor infiltration and mechanical compression.
A comparative, randomized study of low-dose human menopausal gonadotropin and follicle-stimulating hormone in women with polycystic ovarian syndrome. Treatment with low-dose follicle-stimulating hormone (FSH) is associated with a high rate of ovulation in anovulatory women with polycystic ovarian syndrome (PCOS), but it is not clear whether the success of treatment is because of the use of pure FSH or the low dose of gonadotropin. We undertook a randomized controlled study to compare the effects of urinary FSH and human menopausal gonadotropin (hMG) using a low-dose regimen in 30 women with PCOS. Each subject received a maximum of three cycles of either FSH or hMG. Ovulation occurred in 75% of subjects and in 77% of cycles induced with FSH and in 94% of women, 85% of cycles of those treated with hMG. A single dominant follicle developed in 70% (FSH) and 65% (hMG) of cycles, respectively. Five singleton pregnancies occurred in each group. This study shows that low-dose FSH and hMG are equally successful in inducing ovulation, suggesting that the success of treatment depends on the low dose of gonadotropin used rather than the presence or absence of luteinizing hormone in the preparation.
Platelet aggregating activity in serum from patients with HLA-B27 associated rheumatic and cardiac disorders: a possible link to the proliferative vascular changes. OBJECTIVE--To search for possible serum factors (immunochemical abnormalities) that reflect HLA-B27 associated inflammatory process with the proliferative endarteritis, which is an important cause of severe bradycardia and aortic valve regurgitation. PATIENTS AND METHODS--Seventy four men with pacemakers were studied: 24 were HLA-B27 positive and had associated rheumatic and cardiac disorders, 13 were B27 positive but had no clinical or radiographic signs of a related rheumatic condition, and 37 were B27 negative controls. Randomly obtained serum samples were examined for a series of serum factors. RESULTS--Thirteen (57%) of the 23 patients with HLA-B27 and associated rheumatic and cardiac conditions had platelet aggregating activity in their serum. No such activity was found in sera from patients in the other groups. None the less, immunochemical abnormalities were common among patients of all groups; 30 (41%) had antinuclear antibodies or rheumatoid factor or both. CONCLUSION--The platelet aggregating activity found in patients with HLA-B27 and associated rheumatic and cardiac conditions may reflect serum factors that increase the stickiness of platelets and increase their adhesion to the vessel wall. This suggests a link via release of platelet derived growth factor(s) with the characteristic histopathological feature of proliferative endarteritis. Immunochemical abnormalities were common in serum from all men with pacemakers.
Tertiary syphilis of the face. We report a case of noduloulcerative tertiary syphilis that had gone misdiagnosed as discoid lupus erythematosus for many years. This case is noteworthy for (1) a Jarisch-Herxheimer-like reaction, (2) a dramatic response to penicillin therapy despite the presence of long-standing disease, and (3) posttreatment granulomas of possible hypersensitivity origin.
Detection of human papillomavirus in head and neck tumors with DNA hybridization and immunohistochemical analysis. The presence of human papillomavirus (HPV) DNA in oral, sinus, pharynx, and larynx lesions of Japanese patients was studied by Southern blot hybridization under less stringent (25% formamide, 42 degrees C) and stringent (50% formamide, 42 degrees C) conditions. Three samples from 10 benign tumors, and 3 of 30 malignant tumors, contained HPV DNA or HPV-related sequences. The HPV DNAs harbored in three laryngeal papillomas were HPV-11, -6, and -6 or -11, respectively. The HPV DNA and viral capsid antigens were easily detected by in situ hybridization, Western blotting, and peroxidase-antiperoxidase staining. However, neither the typical restriction pattern of HPV DNA nor viral antigen was identified in the malignant tumors, suggesting that subgenomic fragments remained integrated in the host cell DNA.
Diagnostic relevance of trigeminal evoked potentials following infraorbital nerve stimulation. A new tool in neurophysiological exploration of the trigeminal nerve has recently been introduced. It has been demonstrated that stimulation of the infraorbital nerve trunk gives rise to very reliable scalp responses reflecting the activity of the afferent pathway between the maximally nerve and the brain stem. The authors demonstrate that alterations of such trigeminal evoked responses fit with documented pathological processes at various locations along the trigeminal pathway (maxillary sinus, parasellar region, and within the brain-stem parenchyma). They report the findings in 68 patients suffering from "idiopathic" trigeminal neuralgia. Alterations of the response were detected in 33 cases, suggesting that some damage of the nerve had taken place either at the root entry zone into the pons (23 cases) or slightly distal to it (10 cases). Such results support the hypothesis that trigeminal neuralgia may be due to a compression of the trigeminal root at the pons entry zone.