shukoor65/lab-rag-model huggingface dataset:
Longitudinal analyses of respiratory chemosensitivity in normal subjects. To evaluate relative contributions of inherent versus extrinsic factors to respiratory chemosensitivity, ventilatory responses to isocapnic progressive hypoxia and normoxic progressive hypercapnia were examined at intervals of 8 to 10 yr in 32 healthy male volunteers aged 42.2 +/- 1.4 yr (SEM) in the final examination. The volunteers included 22 sons of patients with chronic obstructive pulmonary disease. The mean value for the slope factor of the end-tidal PO2-ventilation hyperbola (A) significantly decreased from 98.3 +/- 12.2 to 77.4 +/- 10.3 L/min mm Hg (p less than 0.05), but that for the end-tidal PCO2 ventilation line (S) did not change over the years. The individual values for the hypoxic ventilatory response were significantly correlated (r = 0.63, p less than 0.001) between the initial and final examinations but not so for the hypercapnic ventilatory response (r = 0.23, NS), suggesting that the latter is more subject to influence from extrinsic factors than the former in the long term. The reproducibility of both tests expressed as coefficients of variation was similar or rather small for the hypercapnic ventilatory response, which was determined by three consecutive measurements at 1 wk intervals in a different group of six subjects. From these data we conclude that hypoxic chemosensitivity is more determined by factors inherent to the individual than hypercapnic chemosensitivity and that it is more systematically influenced by temporal factors, as demonstrated by the systematic decrease over the years.
Familial leg ulcers of juvenile onset Chronic ulceration of the legs was found in the propositus and in ten male relatives in a family of Iraqi Jews. All eleven males had juvenile onset of symptoms. Venous lesions with ulceration were found in two of the propositus' brothers and without ulceration in his three sisters. The findings suggest an autosomal dominant sex-limited genetic defect.
The influence of volume on the tolerance of the brain to radiosurgery. Radiosurgery (delivery of a high dose of radiation to a small volume of the brain) is usually well tolerated since the volume of brain irradiated is small. Despite growing interest in radiosurgery, the influence of the volume of brain irradiated on the tolerance of the brain to radiation is not well understood. The results of six studies reporting clinically significant radiation reactions following radiosurgery for arteriovenous malformations are reviewed. In the combined series, 23 (9%) of 255 patients developed a clinically significant radiation reaction. The volume of brain irradiated and the dose delivered in each of these 23 patients are presented. The compiled data suggest that the previously presented guidelines may underestimate the risks of radiosurgery. Additional clinical and experimental data are needed to determine "safe" doses of radiation to be used during radiosurgery.
Influence of coronary collateral vessels on myocardial infarct size in humans. Results of phase I thrombolysis in myocardial infarction (TIMI) trial. The TIMI Investigators BACKGROUND. The influence of coronary collateral vessels on infarct size in humans remains controversial, partly because no previous study has examined the impact of collaterals present at the onset of acute myocardial infarction on infarct size. METHODS AND RESULTS. The present study used the data base of the Thrombolysis in Myocardial Infarction (TIMI) Phase I trial to correlate the presence or absence of angiographically documented collaterals in the initial hours of myocardial infarct evolution with the size of the infarct as assessed by serial measurements of serum creatine kinase (CK). To avoid the confounding effects of reperfusion on enzymatic estimates of infarct size, this report is limited to those 125 patients who failed to recanalize at 90 minutes after administration of tissue plasminogen activator or streptokinase. Patients with angiographically documented collaterals (group A, n = 51) had significantly lower values of peak serum CK than patients without collaterals (group B, n = 74) (1,877 +/- 216 versus 2,661 +/- 212 IU/l, respectively [mean +/- SEM], p = 0.004). Similarly, CK-derived infarct size estimates were significantly lower in group A than in group B (20.6 +/- 2.5 versus 31.4 +/- 2.8 CK gram equivalents, p = 0.001). The infarct size observed in patients with collaterals was less for anterior infarctions as well as for infarctions of other locations; thus, the beneficial effects of collaterals were independent of the site of the infarct. In 65 of the 125 patients who failed to reperfuse, left ventricular ejection fraction (LVEF) was assessed by contrast ventriculography both at initial cardiac catheterization (before thrombolytic therapy) and at hospital discharge. Among the patients who had both studies, global LVEF tended to increase from pretreatment to hospital discharge in group A (from 50.6 +/- 1.8% to 53.4 +/- 1.8%, p = 0.10) but decreased in group B patients (from 50.3 +/- 1.8% to 47.8 +/- 1.7%, p = 0.02). At hospital discharge, global LVEF was greater in patients with coronary collaterals (53.5 +/- 1.7% versus 49.6 +/- 1.7%, p = 0.01). CONCLUSIONS. The results demonstrate that, in patients in whom thrombolytic therapy fails to induce reperfusion, the presence of coronary collateral vessels at the onset of myocardial infarction is associated with limitation of infarct size as assessed enzymatically and with improved ventricular function on discharge as assessed by LVEF.
Central nervous system monitoring. What helps, what does not. The ICU monitoring of CNS function can make a difference in the clinical outcome. No single technique addresses the multiple issues that arise in the ICU setting, especially for the polytrauma patient. Multimodality approaches combining assessment of cerebral blood flow, electrophysiologic parameters, and intracranial pressure, when appropriate, with cardiac and respiratory monitors are being developed at a number of traumatology centers world wide. Experience needs to be gained to establish the best combination of these modalities. Pending this, selected use of intracranial pressure monitoring combined with EEG and transcranial Doppler ultrasound provides reliable immediate assessment and ongoing monitoring of CNS structures.
Prediction of lymph node involvement in breast cancer by detection of altered glycosylation in the primary tumour. Axillary lymph node metastases at the time of diagnosis of breast cancer is the most accurate predictor of long-term prognosis. However, in patients treated by conservative surgery lymph node status often remains unknown. We have investigated the relation between changes in glycosylation of primary breast cancer cells, as judged by lectin binding, and the presence of axillary lymph node metastases. In a 24-year retrospective study, paraffin-embedded sections of 373 primary breast cancers were stained for the binding of Helix pomatia lectin (HPA). There was a strong association between HPA binding and presence of lymph node metastases, but no association with tumour size, histological grade, S-phase fraction, or patient age at diagnosis. This relation was confirmed by multiple regression analysis (in both survival and relapse free survival models) in which the prognostic significance of HPA binding was lost once nodal status had been introduced into the models. Life tables calculated for lymph-node positive versus lymph-node negative and HPA staining versus non-staining patients were almost identical over 15 years of follow-up. We propose that HPA recognises a glycoprotein that is associated with metastasis (to axillary lymph nodes and elsewhere) and poor prognosis in breast cancer. HPA binding to paraffin sections of primary tumour could aid difficult treatment decisions by providing an additional assessment of staging and likely long-term patient prognosis.
Nocturnal hypoxemia as a determinant of vigilance impairment in sleep apnea syndrome. In sleep apnea syndrome (SAS), vigilance impairment is typically associated with highly disrupted sleep, but recently, nocturnal hypoxemia has also been identified as a second pathogenetic factor in patients with a high degree of desaturation. However, although sleep disruption has been demonstrated to play a role in both the propensity to fall asleep and the capacity to stay awake, the role of nocturnal hypoxemia has been implicated only in the latter. In the present study, both sleep disruption and nocturnal hypoxemia were assessed in 20 moderately to severely apneic patients. During the day, vigilance was assessed both by the multiple sleep latency test (MSLT), as a measure of the propensity to fall asleep, and by the four-choice reaction time test (FCRTT), as a measure of the capacity to stay awake in a performance task. Severity of nocturnal hypoxemia was found to predict performance on the MSLT, as well as on the FCRTT, but sleep disruption was found to predict performance only on the FCRTT. These results suggest that in moderately to severely affected SAS patients, nocturnal hypoxemia may play a primary role in the pathogenesis of vigilance impairment.
In situ oncocytic change in association with multiple renal cell adenocarcinomas. We report a case of in situ oncocytic change in association with two low-grade renal cell adenocarcinomas and one contralateral low-grade oncocytic adenocarcinoma. The in situ oncocytic change showed abundant cytoplasmic mitochondria confirmed by ultrastructural examination and phosphotungstic acid-hemotoxylin staining. In addition, this in situ oncocytic change expressed cytokeratin CAM 5.2 in the absence of cytokeratin AE1/AE3, as reported in oncocytic renal cell adenocarcinomas. Further study of in situ oncocytic change identified in kidneys resected for adenocarcinomas with regard to follow-up and management of the contralateral kidney seems indicated.
Effects of asymptomatic ischemia on long-term prognosis in chronic stable coronary disease. BACKGROUND. Ischemia on ambulatory electrocardiographic monitoring has been shown to adversely affect short-term prognoses in patients with unstable angina, after myocardial infarction, and with chronic stable angina. METHODS AND RESULTS. In this long-term study, we followed 138 patients (mean age, 59 +/- 9 years) with chronic stable angina and positive exercise tests for cardiac events (e.g. death, myocardial infarction, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery). In 105 patients, ambulatory electrocardiographic monitoring was performed after all antianginal medication was withheld for 48 hours. In 26 patients, the diagnostic tests were repeated while on their usual medication. In addition to the 105 patients, 33 patients had their monitoring performed only while on their usual medication. During 37 +/- 17 months of follow-up, there were nine deaths, nine myocardial infarctions, and 35 revascularization procedures. In patients monitored off medication, Cox survival analysis showed that the occurrence of ischemia on electrocardiographic monitoring was the most significant predictor of death and myocardial infarction in the subsequent 2 years (p = 0.02) and all adverse events for 5 years (p = 0.009). Patients who were monitored on medication and did not have ischemia (n = 18) appeared to have more adverse events than patients who had no ischemia while being monitored off medication (n = 43). CONCLUSIONS. Asymptomatic ischemia on ambulatory electrocardiographic monitoring in patients with stable angina predicts death and myocardial infarction for 2 years and all adverse events for 5 years. Monitoring performed while on medication may show no ischemia; however, this may not indicate low risk of future coronary events.
Merkel cell tumour: clinical behaviour and treatment. We have reviewed 30 reports of Merkel cell tumour and described a further five cases in order to establish a database and from this more clearly define the biology of this tumour, prognostic factors that govern outcome, and optimal management. After excision alone of the primary lesion, local recurrence occurred in 39 per cent of patients and regional failure occurred in 46 per cent. In contrast, in patients treated by excision plus prophylactic treatment (adjuvant node dissection and/or adjuvant radiation), local recurrence occurred in 26 per cent and regional failure in 22 per cent. Locoregional recurrence carried an ominous significance with 67 per cent of patients subsequently dying of the disease. For patients who either presented with regional disease or later developed regional disease, the best outcome (44 per cent survival with mean follow-up of 40 months) was obtained following treatment by therapeutic node dissection with or without radiation. In contrast, treatment of regional disease with radiation alone was associated with only a 20 per cent survival rate. Unfavourable prognostic factors included young age, lesions sited in the head and neck or trunk, male sex, and the presence of locoregional failure and/or systemic disease. We conclude that Merkel cell tumours behave in a similar manner to the aggressive variants of melanoma and that minimal treatment consists of wide surgical resection of the primary lesion (with a margin of 2.5-3 cm) coupled with resection and probably also radiation of regional disease if present. In addition, consideration should be given to prophylactic node dissection in node negative patients, especially in those patients with unfavourable prognostic factors.
A contribution to the genetics of febrile seizures: waking and sleep EEG in siblings. Waking and sleep EEGs were recorded in 67 siblings of 52 patients with febrile seizures (FS). Epileptic activity was noted in at least 1 sibling for 28 of the 52 patients (53.8%). Epileptic discharges were noted in 33 (49.2%) of the 67 siblings. Thirty-two siblings had 3-4 Hz spike wave complexes, and 1 sibling had independent centrotemporal spike foci (rolandic foci). Epileptic activity was noted exclusively in the waking state in only 3%, in waking and sleep in 31.3%, and only in sleep in 14.9%. The greatest number of epileptic discharges occurred in waking during hyperventatilation (32.8%) and during stage C sleep (38.8%). In 5 photosensitive siblings, additional epileptic discharges were noted in sleep in 1 and in waking and sleep in 4. At least 1 sibling in 5 (55.6%) of 9 patients with complicated febrile seizures, in 23 (53.5%) of 43 patients with simple FS, and in 4 of 9 patients (44.4%) with later onset epileptic seizures had seizure discharges. At least 1 sibling in 24 of 43 patients (55.8%) with exclusively FS in 13 of 30 (43.3%) male patients and in 15 of 22 (68.2%) female patients had seizure discharges. Siblings aged 6-10 years had (66.7%) the highest rates of activation. Epileptic discharges were noted in 83.3% of siblings with seizures, but in only 45.9% of siblings without seizures. Seizure activity was recorded in 68.2% of siblings who had occipital 3-4-Hz theta-delta-activity but in only 13.0% of siblings without this pattern.
Pulmonary vascular reactivity and permeability to alveolar hypoxia in the dog. Hemodynamics and vascular permeability were studied during acute alveolar hypoxia in isolated canine lung lobes perfused at constant flow with autogenous blood. Hypoxia was induced in the presence (COI + Hypox, n = 6) or absence (Hypox, n = 6) of cyclooxygenase inhibition (COI) with indomethacin or meclofenamate. Hypoxic ventilation reduced blood PO2 from 143 to 25-29 Torr without a change in PCO2. During hypoxia a capillary filtration coefficient (Kf) was obtained gravimetrically as an index of vascular permeability to water. In COI + Hypox, pulmonary arterial pressure (Pa) increased from 11.5 +/- 0.7, post-COI normoxia, to a peak of 22.1 +/- 2.3 during hypoxia (P less than 0.01) without a change in capillary pressure (Pc). In contrast, hypoxia changed neither Pa nor Pc in Hypox relative to an untreated normoxic control group (Normox, n = 6, P greater than 0.05). Kfs (means +/- SE in ml.min-1.Torr-1.100 g-1) for Normox (0.070 +/- 0.014), Hypox (0.082 +/- 0.024), and COI + Hypox (0.057 +/- 0.017) did not differ from one another (P greater than 0.05). Although COI markedly enhanced the pressor response to acute alveolar hypoxia, hypoxia increased neither Pc nor vascular permeability regardless of COI.
Long-term prognosis after early intervention with metoprolol in suspected acute myocardial infarction: experiences from the MIAMI Trial. The MIAMI Trial Research Group. A total of 5778 patients with suspected acute myocardial infarction were randomized to early intravenous metoprolol followed by oral treatment for 15 d, or to placebo. Thereafter, the two groups were treated similarly. During a 1-year follow-up period the mortality in patients who were randomized to early metoprolol was 10.6% compared to 10.7% for placebo (P greater than 0.2). Among patients with a higher risk of death, the tendency towards a reduced mortality in the metoprolol group that was observed after 15 d remained similar after 1 year. It is concluded that early intervention with metoprolol in suspected acute myocardial infarction did not improve the long-term prognosis compared to placebo treatment.
Pediatric Advanced Life Support: Part II. Fluid therapy, medications and dysrhythmias. The first part of this two-part article discussed the equipment needed for pediatric resuscitations and the techniques used for cardiopulmonary assessment, airway securance, circulatory maintenance and intravascular access. In this second part, additional life support measures are reviewed, including fluid therapy, resuscitation medications and the management of cardiac rhythm disturbances.
Hepatitis B virus infection in patients with idiopathic liver disease. We studied 67 HBsAg-negative Israeli patients (36 negative for all HBV serological markers as group 1 and 31 positive for antibodies to HBs and HBc as group 2) with chronic liver disease and cirrhosis of unknown origin using a rapid, sensitive and specific assay for the detection of low levels of hepatitis B virus in serum. This technique uses a high-affinity monoclonal antibody to HBs against an a domain epitope of HBsAg to capture the virion, followed by hepatitis B virus DNA amplification with the polymerase chain reaction. In addition, 55 subjects without liver disease served as controls: Group 3 (n = 32) was negative for all hepatitis B virus markers; group 4 (n = 23) was positive for antibodies to HBs and HBc. We found 11 individuals in group 1 (31%) and 10 in group 2 (29%) harboring low levels of hepatitis B virus DNA in serum. In contrast, no one in group 3 or group 4 was positive by this technique (p less than 0.0001). Using polymerase chain reaction primers spanning other regions of the hepatitis B virus genome and a method of restriction-fragment analysis of polymerase chain reaction-amplified sequences, we detected significant DNA sequence heterogeneity, suggesting infection with distinct hepatitis B virus strains. DNA extracted from paraffin-embedded liver biopsy specimens of 42 patients from groups 1 and 2 was shown to contain hepatitis B virus DNA by polymerase chain reaction in 11 of 12 patients with circulating virion DNA. More important, 18 additional patients whose sera were negative by HBs-antibody capture/polymerase chain reaction amplification had hepatitis B virus DNA sequences in their livers.
Effects of DuP 753 on renal function of normotensive and spontaneously hypertensive rats. This study examined the effects of a new, orally-active, nonpeptide angiotensin II (AII) receptor antagonist, 2-n-butyl-4-chloro-5-hydroxymethyl-1-[2'-(1H-tetrazol-5-yl)biph eny l-4- yl)methyl] imidazole, DuP 753, on renal function of anesthetized, volume-expanded Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHR), and in a group of euvolemic Munich-Wistar (MW) rats. Plasma renin activities were similar and averaged 4.4 +/- 0.7 and 4.3 +/- 1.4 ng AI/mL.h, respectively, in the SHR and WKY rats. In WKY rats (n = 15), DuP 753 (2 or 10 mg/kg, intravenously) had no effect on urine flow, sodium excretion, renal blood flow (RBF), or glomerular filtration rate (GFR). Fractional excretion of lithium (FELi) rose from 32 +/- 5 to 40 +/- 4% of the filtered load and arterial pressure decreased slightly from 129 +/- 2 to 122 +/- 2 mm Hg. In SHR (n = 9), urine flow fell 24%, and FELi and RBF increased by 27% and 30%, respectively, after 2 mg/kg DuP 753, but sodium excretion, GFR, and arterial pressure were not significantly altered. A higher dose of DuP 753 (10 mg/kg; n = 8) reduced arterial pressure, urine flow, and sodium excretion in the SHR. RBF increased 34%, while GFR and FELi were not significantly altered. Similar effects were seen in SHR (n = 11), given an equivalent antihypertensive dose of captopril (20 mg/kg). In euvolemic MW rats in which plasma renin activity was elevated to 18.8 +/- 3.3 ng AI/mL.h, DuP 753 (2 mg/kg, n = 7) increased RBF, urine flow, and sodium excretion, while mean arterial pressure and GFR were unaltered.
Right atrial extension of an embryonal carcinoma of the testis. A case of embryonal carcinoma of the testis extending into the inferior vena cava and the right atrium is presented. Tumor extension was demonstrated preoperatively by computed axial tomography. Successful resection of the intravascular and right atrial extension was achieved using extracorporeal circulation. It is concluded that intravascular and right atrial extension is not a contraindication to radical surgery. This type of metastasis raises the same therapeutic and prognostic problems as those raised by tumor masses in the lungs or lymph nodes found after chemotherapy for malignant nonseminomatous germ cell tumor of the testis.
Muscle perfusion with technetium-MIBI in lower extremity peripheral arterial diseases. There have been several methods utilized in the diagnosis or assessment of medical or surgical treatments of peripheral arterial diseases. In this study, the diagnostic value of a new tracer: 99mTc-methoxy-isobutyl-isonitrile (MIBI) has been demonstrated in patients with leg claudication. We successively performed muscle perfusion scans in 6 normals and 18 patients with claudication pain during rest and after exercise on the same day. Muscle perfusion abnormalities in all patients were consistent with the defects in the arteries of the affected limbs. The results show that this is a simple and accurate diagnostic procedure and superior to those that have been previously used.
Severity of coronary artery disease in young patients with insulin-dependent diabetes mellitus. Cardiovascular events remain a leading cause of morbidity and mortality in patients with juvenile-onset, insulin-dependent diabetes mellitus. To examine the extent and severity of the atherosclerotic lesions underlying this excess morbidity and mortality, clinical and angiographic findings were examined in 32 patients with insulin-dependent diabetes and in 31 nondiabetic patients, matched for age and symptoms, undergoing elective cardiac catheterization for evaluation of coronary artery disease. With respect to the individuals without diabetes, patients with insulin-dependent diabetes were significantly more likely to have severe narrowings, to have them in all three major coronary arteries, and to have them in distal segments. Severe narrowing of multiple vessels was significantly more common in men than in women and in individuals with hypercholesterolemia. We conclude that the high risk of cardiovascular events observed in young patients with insulin-dependent diabetes is secondary to advanced atherosclerotic lesions in coronary arteries. Involvement of distal segments of coronary arteries make these patients frequently unsuitable for bypass grafts.