shukoor65/lab-rag-model huggingface dataset:
Preimplantation genetics: chromosomes of fragmented human embryos. STUDY OBJECTIVE: To examine the chromosome makeup of fragmented human embryos. DESIGN: Prospective. SETTING: Assisted reproductive technology (ART) program. PATIENTS: One hundred twenty-one poor-quality embryos from 58 patients 31 to 40 years of age admitted for an ART program were examined for chromosome makeup. RESULTS: Chromosome anomalies were observed in 31.9% (29/91) of poor-quality embryos, 19.8% (18/91) displayed mosaicism (diploid/haploid, diploid/triploid, diploid/aneuploid), 5.5% (5/91) showed polyploidy, 2.2% (2/91) had pulverized chromosomes, 2.2% (2/91) revealed aneuploidy, 1.1% (1/91) had prematurely condensed chromosomes, and 1.1% (1/91) had structural rearrangements involving chromosome number 2. The mean age of patients showing anomalies (36.5 years) was not significantly higher than the mean for the entire group (35.5 years). CONCLUSIONS: The incidence of chromosome anomalies in fragmented human embryos is high. These anomalies originate either in the gametes or through mitotic nondisjunction within the embryos. It is not advisable to replace such embryos into patients going through in vitro fertilization.
Growth-hormone releasing hormone in a bronchial carcinoid. The case is reported of a 43-year-old patient with a peripherally located bronchial carcinoid tumor containing large amounts of immunoreactive and bioactive growth-hormone releasing hormone (GHRH). Because no GHRH was found in the peripheral circulation, there was no quantitative or qualitative derangement of growth-hormone secretion. The tumor was excised completely by thoracotomy.
Abdominal cerebrospinal fluid pseudocyst: occurrence after intraperitoneal urological surgery in children with ventriculoperitoneal shunts. Increasingly, children with ventriculoperitoneal shunts are undergoing urinary tract reconstructive surgery with bowel. The peritoneal end of the ventriculoperitoneal shunt tubing usually is exposed during the procedure, making the system vulnerable to infections and malfunction. The records of 103 myelomeningocele children with ventriculoperitoneal shunts and bowel-bladder reconstructive surgical procedures (27) were reviewed for evidence of an abdominal cerebrospinal fluid pseudocyst (6). Pseudocyst formation occurred in only 1 of 76 ventriculoperitoneal shunt patients (1.3%) who had not undergone versus 6 of 27 (22%) who had undergone an intra-abdominal procedure. The 6 children had a total of 8 pseudocysts, including 7 pseudocysts that developed 8 days to 47 months (average 15.1 months) after the reconstructive surgery and 1 that developed before reconstructive surgery. All patients had abdominal symptoms (pain or mass) or symptoms of increased intracranial pressure. Treatment included computerized tomography-guided needle aspiration or abdominal exploration with cyst evacuation and shunt repositioning or replacement. The walls of the pseudocyst were formed by matted loops of bowel. Additional shunt surgery was required in 5 patients with conversion to ventriculoatrial shunts. We conclude that the development of an abdominal cerebrospinal fluid pseudocyst is at least in part related to the prior abdominal surgery. Thus, pediatric urological and general surgeons caring for children with ventriculoperitoneal shunts should be aware of this complication.
Mechanism of the increased ventilatory response to exercise in patients with chronic heart failure. Minute ventilation, respiratory rate, and metabolic gas exchange were measured continuously during maximal symptom limited treadmill exercise in 30 patients with stable chronic heart failure. The ventilatory response to exercise was assessed by calculation of the slope of the relation between minute ventilation and rate of carbon dioxide production. There was a close correlation between the severity of heart failure, determined as the maximal rate of oxygen consumption, and the ventilatory response to exercise. Reanalysis of the data after correction for ventilation of anatomical dead space did not significantly weaken the correlation but reduced the slope of the relation by approximately one third. These results show that the increased ventilatory response to exercise in patients with chronic heart failure is largely caused by mechanisms other than increased ventilation of anatomical dead space. This finding supports the concept that a significant pulmonary ventilation/perfusion mismatch develops in patients with chronic heart failure and suggests that the magnitude of this abnormality is directly related to the severity of chronic heart failure.
Mania in the elderly: a 5-7 year follow-up. A 5-7 year follow-up study of elderly individuals hospitalized on an acute psychiatric inpatient service for bipolar disorder, manic phase, demonstrates that the prognosis of mania has improved in the past 30 years. A majority of those hospitalized for mania are alive and living independently 5 years after hospitalization. However, eight of 25 (32%) patients have experienced a decline in Mini-Mental State Exam score to below 24, suggesting a clinically significant cognitive disorder. Mortality rates were higher in the manic group than expected from population norms. Compared to a group of similarly aged individuals hospitalized for unipolar depression, patients with bipolar disorder had an earlier age of onset and a lesser likelihood of being rehospitalized.
Failed in vitro fertilization of human oocytes: a cytogenetic analysis. OBJECTIVE: To investigate possible causes of in vitro fertilization (IVF) failure. DESIGN: A retrospective cytogenetic study of human oocytes divided into four groups or, alternatively, into two groups according to fertilization rates and whether the patients became pregnant or not. Two additional groups included oocytes in which there was no or only partial fertilization. SETTING: Primary treatment of infertility in an institutional practice. PATIENTS, PARTICIPANTS: Two hundred fifty-three inseminated-unfertilized oocytes from 87 women entering the IVF program because of tubal, unknown, and male infertility. Immunological infertility was excluded. INTERVENTIONS: Ultrasound-guided transvaginal follicular aspiration. MAIN OUTCOME MEASURE(S): Planned after data collection. RESULTS: The rate of chromosome anomalies did not show any significant difference among the four groups established according to the fertilization rate and between pregnant and nonpregnant patients. Independently, our data identified male factor as responsible for 41%, chromosome anomalies 19.3%, oocyte immaturity 11.8%, and unknown etiology 41% of fertilization failures (based on analysis of 161 oocytes). CONCLUSIONS: Fertilization rate and pregnancy outcome after IVF are not related to the incidence of oocyte chromosome anomalies.
The survival of total knee arthroplasty in patients with osteonecrosis of the medial condyle. The results of total knee arthroplasty in patients with osteonecrosis of the medial femoral condyle were examined using Kaplan-Meier survival analysis. The study included 32 osteonecrotic knees with an average final follow-up examination of 3.9 years. For comparison, 63 osteoarthrotic knees with an average final follow-up examination of 4.6 years were also analyzed. The survival rates were calculated using four distinct categories of failure: (1) revision, (2) revision or radiolucency, (3) revision, radiolucency, or pain, and (4) pain. On the basis of pain relief alone, the five-year postoperative success rate was 82% for osteonecrosis (eight knees) and 90% for osteoarthrosis (27 knees), with no significant statistical difference between the two groups.
Postoperative hyperbilirubinemia after resection of thoracic esophageal cancer. The rate of occurrence of postoperative hyperbilirubinemia (PHB) following esophagectomy for thoracic esophageal cancer was 67%, 115/171 cases, which was significantly higher than those following total gastrectomy (28%, 40/144 cases) and colectomy (12%, 7/59 cases). Among the operative procedures, right thoracotomy with extensive lymphoadenectomy had the highest rate of PHB (87%), perhaps due to the longest operation time and the largest intraoperative blood loss. Preoperative risk factors were glucose intolerance, reduced lymphocyte count, and poor nutritional state. The change in bile acid composition, as well as the elevation of alkaline phosphatase and gamma-glutamyl transpeptidase, indicated the presence of postoperative cholestasis which was relevant to total parenteral nutrition. The results suggest that the development of PHB was related to the extent of surgery and the use of parenteral nutrition.
Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma. We retrospectively analyzed the likelihood of regional nodal failure (RNF) for 1,624 patients with stage I or II invasive breast carcinoma treated with conservative surgery and radiotherapy (RT) at the Joint Center for Radiation Therapy (JCRT) between 1968 and 1985. The median follow-up time was 77 months. RNF was the first site of failure for 38 of the 1,624 patients (2.3%). The incidence of axillary failure for patients undergoing axillary dissection (AXD) who were irradiated to the breast only was 2.1% (nine of 420) for patients with negative nodes and 2.1% (one of 47) for patients with one to three positive nodes. The incidence of supraclavicular failure in these two groups was 1.9% (eight of 420) and 0% (zero of 47), respectively. The incidences of axillary and supraclavicular failure in patients without clinically suspicious axillary involvement who did not have AXD but were treated with RT were 0.8% (three of 355) and 0.3% (one of 364), respectively. Despite various combinations of salvage surgery, RT, and systemic therapy, only 47% of patients (18 of 38) achieved complete regional control after nodal relapse. We conclude that RNF is uncommon in patients treated to the breast alone following an adequate AXD when the axillary nodes are negative or when one to three nodes are positive. RNF is also uncommon in patients with a clinically uninvolved axilla treated with nodal RT without AXD. Symptoms of RNF can be controlled in most but not all patients. Further study is needed to determine if the benefits of RT in preventing a small number of symptomatic RNF outweigh the potential toxicity for any subgroup of patients.
Open, double-blind and long-term study of vigabatrin in chronic epilepsy. We performed an open, double-blind, and long-term study of vigabatrin (gamma-vinyl-GABA, GVG) in patients with treatment-resistant epilepsy who were receiving only one or at most two standard antiepileptic drugs (AEDs). The novel design included a parallel, double-blind, placebo-controlled phase that minimized the number of patients receiving placebo and allowed determination of the optimum dose of GVG for each patient before initiation of the double-blind phase. The study was divided into four phases. The first phase was a 6-week period of baseline observation. In the second phase, GVG was added openly to previous AEDs for 8 weeks. During the first 2 weeks of this phase, the dose of GVG was increased weekly and then, in the absence of adverse effects, was held constant for the next 6 weeks. At the end of this open phase, seizure frequency during the 6 weeks of constant treatment was compared with the baseline seizure frequency for each patient. Patients who experienced reduction greater than 50% in the frequency of any seizure type during the open phase were defined as responders. These responders were then entered into the third and double-blind phase, in which they were randomly allocated wither to continue active GVG treatment or placebo for 8 weeks. Thirty-three patients entered the study; 31 of 33 patients completed the initial open phase. Twenty patients achieved a reduction greater than or equal to 50% in the frequency of one or more seizure types and were eligible for the double-blind phase; 10 were randomized to continue GVG and 10 were randomized to placebo.
Spinal anaesthesia for inguinal hernia repair in high-risk neonates. To avoid the high incidence of respiratory complications associated with general anaesthesia in premature neonates, 44 spinal anaesthetics for inguinal hernia repair in very low birthweight infants were administered in 47 attempts. Hyperbaric tetracaine with epinephrine 1:200,000 was administered in a dose range of 0.27-1.10 mg.kg-1. Attempted lumbar puncture failed in three infants. In 24 procedures, spinal anaesthesia alone provided satisfactory operating conditions; in 20, supplementary inhalational general anaesthesia or iv ketamine was necessary. Perioperative apnoeic episodes requiring bag/mask assisted ventilation occurred in six infants. In five infants, apnoeic spells occurred in the postoperative period. No infant required tracheal intubation; there was no haemodynamic instability. Twenty-four infants required no postoperative analgesia. Our experience suggests that spinal anaesthesia for inguinal hernia repair in very low birth weight infants reduces but does not eliminate the risk of respiratory instability, and that supplementary anaesthesia is often necessary to provide satisfactory operating conditions.
Turcot's syndrome. Flow cytometric analysis. Turcot's syndrome is a rare, genetically transmittable disease in which patients with colonic polyposis (possibly complicated by the progression to adenocarcinoma) have malignant central nervous system neoplasms. Dominant, recessive, and sporadic cases have been described. A 26-year-old man is reported with no relevant family history who had intermittent abdominal discomfort in 1986. Sigmoidoscopy revealed numerous polyps, several of which showed carcinomatous change. Dukes' Stage C colorectal carcinoma was diagnosed. Treatment consisted of total colectomy with construction of a Koch's pouch. He remained well for 3 years until onset of headache, nausea, and vomiting. Computed tomographic scan disclosed a large, circumscribed, enhancing, right frontoparietal mass. After craniotomy and partial resection, histologic review disclosed anaplastic astrocytoma. He received cranial radiation therapy, 6000 cGy, by parallel opposed ports to the tumor bed, and carmustine 200 mg/m2 intravenously every 8 weeks. Flow cytometric DNA analysis was done on the paraffin-embedded archival material from the patient's normal colon, colonic adenocarcinoma, and anaplastic astrocytoma. DNA histograms revealed diploid distributions in all three samples. The G2/M fraction of the astrocytoma was elevated at 16%, and the S-phase fraction of the colonic adenocarcinoma was 19.4%.
Immediate vs. delayed treatment of group A beta-hemolytic streptococcal pharyngitis with penicillin V. Three hundred six children with probable Group A beta-hemolytic streptococcal pharyngitis were enrolled in a randomized double blind trial to compare the effects of immediate vs. delayed treatment with oral penicillin V. Among the 229 culture-positive patients, 111 were randomly assigned to receive penicillin V immediately and 118 to receive a placebo for 48 to 52 hours followed by penicillin V. Patients were evaluated clinically for 48 to 52 hours following initiation of treatment. The Streptozyme test was used to measure acute to convalescent antibody titer. Both regimens resulted in a greater than 92% cure rate. Early treatment was associated with significantly fewer and milder signs and symptoms on Day 3 and a significantly lower rise in the antibody titer. On the other hand we found 8 (7%) relapses and 18 (16%) early and 14 (13%) late recurrences in this group; all were significantly higher than the corresponding numbers of 2 (2%), 6 (5%) and 4 (3%), respectively, in the late treatment group. This study shows the beneficial effect of early treatment with penicillin V on the clinical course of Group A beta-hemolytic streptococcal pharyngitis. This study also shows that delayed penicillin treatment may be associated with a lower incidence of subsequent Group A beta-hemolytic streptococcal pharyngitis.
Induction of nm23 gene expression in human colonic neoplasms and equal expression in colon tumors of high and low metastatic potential. Levels of expression of the murine nm23 gene inversely correlate with metastatic potential in several rodent tumor model systems. Expression of the human nm23 homologue also is lower in human breast cancers of high metastatic potential than in breast cancers of low metastatic potential. In the present study, we examined changes in nm23 expression during colon carcinogenesis as found in 18 matched pairs of normal and neoplastic human colon tissues. We found that a 0.8-kilo-base nm23 transcript was expressed in all samples of morphologically normal colon mucosa. In 16 of 18 colon neoplasms, nm23 expression was further increased in the neoplastic, compared with the morphologically normal, colon mucosa from the same individual. Expression of nm23 was elevated over normal mucosa in 3 of 3 polyps, in 2 of 3 nonmetastatic cancers, and in 11 of the 12 cancers that were metastatic at the initial presentation. The levels of nm23 expressed were similar in the 12 metastatic colon neoplasms and in the 6 colon neoplasms of lower clinical stage. In addition, nm23 expression was maintained in culture in each of 12 cell lines initiated from human colon neoplasms and did not differ between lines established from neoplasms of high or low metastatic capability. We concluded that nm23 was expressed in normal colon mucosa. Expression of nm23 increased during early stages of colon carcinogenesis and remained increased in metastatic colon cancer. Therefore, in the colon, tissue-specific events dissociate nm23 expression from loss of tumor metastatic competence.
The heterogeneity of human chorionic gonadotropin (hCG). III. The occurrence and biological and immunological activities of nicked hCG. Nicks, or missing peptide linkages, have been found in hCG beta-subunit between residues 44 and 45 and between residues 47 and 48. We examined the occurrence and biological and immunological activities of nicked hCG. As shown by sequence analysis, CR127 standard hCG is approximately 20% nicked, half at beta 44-45 and half at beta 47-48. Treatment with human leukocyte elastase increased the extent of nicking of CR127 standard hCG. The longer the incubation of CR127 standard with human leukocyte elastase (0, 2, and 21 h), the greater the extent of nicked hCG (20%, 46%, and 89%). As the extent of nicking increased, the receptor-binding ability diminished, as did the ability to stimulate progesterone production by rat corpus luteal cells in vitro (0.9, 0.74, and 0.29 microgram/microgram hCG, respectively). In a regression analysis, a linear relationship was indicated between the extent of nicking and receptor binding values (97% correlation) and between the extent of nicking and steroidogenic activity in vitro (99% correlation). From the intercepts of the regression lines, it was estimated that nicks reduced receptor binding by 11-fold and reduced the steroidogenic activity of hCG by 5-fold. We examined eight individual hCG preparations, three purified from pregnancy urine, three from urine from patients with hydatidiform mole, and two from urine from women with choriocarcinoma. In descending order, the eight individual hCG preparations were 100%, 100%, 85%, 76%, 42%, 41%, 0%, and 0% intact. Although no correlation was observed between the percent intact and the ability of the eight individual samples to displace 50% [125I]hCG in binding CG/LH receptor (r less than 0.5), a close correlation was noted between the percent intact and the steroidogenic activity in vitro (98% correlation). This separated the effects of nicking on receptor binding and steroidogenic activities and indicated that while multiple factors influence receptor binding, only nicking suppresses the steroidogenic activity of bound hCG. We examined the recognition of nicked hCG molecules by different hCG immunoassays. The Hybritech Tandem assay measured total hCG and did not distinguish nicked and intact hCG molecules (in a regression analysis, immunoactivity vs. percent intact hCG, r less than 0.5). In contrast, the immunometric assay using B109 hCG dimer-specific monoclonal antibody and anti-beta-peroxidase only detected the intact component of hCG (in a regression analysis, immunoreactivity vs. percent intact hCG, 98% correlation). We used these assays together to estimate the percentage of intact hCG and to deduce the extent of nicking.(ABSTRACT TRUNCATED AT 400 WORDS).
Sodium channel density in hypomyelinated brain increased by myelin basic protein gene deletion. Trophic control over the expression and membrane distribution of voltage-dependent ion channels is one of the principal organizing events underlying the maturation of excitable cells. The myelin sheath is a major structural determinant of regional ion channel topography in central axons, but the exact molecular signals that mediate local interactions between the oligodendrocyte and axolemma are not known. We have found that large caliber fibre pathways in the brain of the mutant mouse shiverer (shi, gene on chromosome 18), whose developmental fate of myelination is averted by deletion of five exons in the myelin basic protein gene, have a striking excess of sodium channels. As cytoplasmic membranes of shiverer oligodendroglia still adhere to axons, the evidence indicates that myelin basic protein or a myelin basic protein-dependent glial transmembrane signal associated with compact myelin formation, rather than a simple glial-axon contact inhibition or an intrinsic genetic program of neuronal differentiation, could be critical in downregulating sodium channel density in axons. Here we use the shiverer mutant to show that mature central nervous system projection neurons with large caliber unmyelinated fibres sustain functional excitability by increasing sodium channel density. This axon plasticity, triggered by the absence of a single glial protein, contributes to the unexpectedly mild degree of neurological impairment in the mutant brain without myelin, and may be a potentially inducible mechanism determining the recovery of function from dysmyelinating disease.
Cholestatic liver reaction during heparin therapy. Three patients are reported who developed liver enzyme abnormalities of a cholestatic pattern, without jaundice, after 10-28 d of heparin treatment. The values normalized within 4 months in all patients. Thus heparin should be added to the list of drugs that may cause a cholestatic liver reaction.
Massive acute arsenic poisoning. A 28-year-old male ingested 75 g of arsenic trioxide in a successful suicide attempt. The presentation, management and postmortem findings are presented and discussed.
Hypercarbic periodic breathing during sleep in a child with a central nervous system tumor. A 4-yr-old girl with a ganglioglioma involving the cerebellum and pons presented with CO2 retention and arterial O2 desaturation during wakefulness and sleep. Despite the presence of a regular respiratory pattern during wakefulness, NREM sleep was associated with the appearance of a sustained periodic respiratory pattern characterized by clusters of usually two breaths separated by an 8 to 10-s expiratory pause. At sleep onset, this Biot's respiratory pattern appeared immediately after a sigh. Breathing frequency during NREM sleep became regular with administration of supplemental O2 and an attendant increase in end-tidal CO2. Shortly after withdrawal of supplemental O2 during NREM sleep, the periodic pattern resumed and was again immediately preceded by a sigh. The observations during NREM sleep in this patient with a central nervous system abnormality indicate that Biot's type respiratory pattern may be reversed by administration of supplemental oxygen. The results in this patient suggest: (1) the presence of a very elevated CO2 apnea threshold, and (2) that the pons may play a role in determining the effect of hypercapnic hypoxia on respiratory pattern during sleep.