shukoor65/lab-rag-model huggingface dataset:
Results of treatment with high intensity, brief duration chemotherapy in poor prognosis non-Hodgkin's lymphoma. A novel chemotherapeutic approach was designed for the treatment of intermediate and high-grade histology non-Hodgkin's lymphoma using augmented (but subtransplantation) doses of chemotherapy administered at frequent intervals in the inpatient setting. For the initial evaluation of this regimen, poor prognosis patients were treated with a projected long-term survival rate of less than 25% in response to standard therapy. Between March 1982 and May 1988, 56 previously untreated patients were entered into this study; all patients had either high-grade histology (20 patients) or predominantly large cell lymphoma (36 patients). Median age was 41.5 years (range, 18 to 69 years). Poor prognosis features included: Stage IV, 71%; poor performance status (Eastern Cooperative Oncology Group scale, 2 to 4), 55%; multiple extranodal sites of disease, 52%; elevated lactic dehydrogenase (greater than 300 IU/l), 43%; and bulky (greater than 10 cm) tumor masses, 30%. Thirty-three of 56 patients (59%) were in Shipp's Category 3. During the 6-year study, the chemotherapy regimen was modified in an attempt to improve efficacy and reduce toxicity. However, most patients received a 2-month course of therapy as follows: cyclophosphamide 1500 mg/m2 intravenously (IV) on days 1, 2, and 29; etoposide 400 mg/m2 IV on days 1, 2, and 3 and 100 mg/m2 on days 29, 30, 31; doxorubicin 45 mg/m2 IV on days 29, 30; vincristine 1.4 mg/m2 IV on days 8, 22, 36, and 50; bleomycin 10 units/m2 IV on days 8, 22, 36, and 50; methotrexate 200 mg/m2 IV on days 15 and 43 followed 24 hours later by leucovorin 15 mg/m2 IV every 6 hours for six doses; and prednisone 60 mg/m2 orally on days 1 to 7 and 29 to 35. The complete response (CR) rate was 77% (95% confidence interval, 64% to 86%). There were ten relapses, only one of which occurred after 18 months of follow-up. Overall event-free survival (EFS) was 52% (95% confidence interval, 36% to 68%), with a median follow-up of 36 months. Eleven of 13 patients with small noncleaved lymphoma had CR; actuarial EFS in this subgroup was 61%. Myelosuppression occurred in all patients, with severe leukopenia (less than 1000/microliters) lasting a median of 12 days (range, 3 to 29 days); toxic deaths occurred in five patients (9%; 95% confidence interval, 4% to 19%). This intensive approach improved the response and survival of very poor risk non-Hodgkin's lymphoma patients.
Total acromionectomy. A twenty-year review. Thirty-five patients (thirty-eight shoulders) were treated consecutively with a total acromionectomy between 1969 and 1989. At a minimum of two years (average, five years and eight months) after the operation, thirty-one patients (thirty-four shoulders) were available for review. The results, which were rated on the basis of pain, function, range of motion, strength, and the satisfaction of the patient, were excellent for twenty-five shoulders, good for four, fair for three, and poor for one. Four of the five least satisfactory results were in patients who had had a long-standing massive tear of the rotator cuff. This study was done to separate the criticism of the operative procedure of total acromionectomy from an avoidable complication of that procedure, retraction of the deltoid, and to describe the specific advantages and satisfactory results that occur when that complication is avoided. It is my opinion that failure to repair the deltoid adequately results in retraction of that muscle, and that this avoidable complication is responsible for the unfavorable reputation of total acromionectomy.
Ovarian cancer screening in asymptomatic postmenopausal women by transvaginal sonography. From November 1987 to January 1991, 1300 postmenopausal women underwent screening with transvaginal sonography (TVS). Women eligible for screening were all asymptomatic with no known ovarian tumors. Ovarian volume was calculated using the prolate ellipsoid formula, and a value in excess of 8.0 cm3 was considered abnormal. Ovarian abnormalities were detected in 33 women (2.5%), and 27 underwent exploratory laparotomy. Ovarian tumors were noted in all 27 patients, including 2 primary carcinomas and 14 serous cystadenomas. The two women with ovarian carcinomas had normal results of pelvic examinations and normal serum CA-125 levels. Both women had Stage I disease, and are alive and well after conventional therapy. TVS was time efficient, easy to perform, and well-accepted by patients. Currently, there are more than 3000 patient years of follow-up in the screened population, and there have been no deaths due to ovarian cancer. A multi-institutional trial to determine the efficacy of TVS as a screening method for ovarian cancer is indicated.
Recent advances in MR imaging/spectroscopy of cerebral ischemia. Recent advances in high-resolution MR imaging and multinuclear spectroscopy have stimulated studies of the functional relationships between tissue hypoperfusion, cellular energy depletion, and brain edema associated with cerebral ischemia. The very slow (microns/sec) random translational motion of water protons in various brain tissues and intracranial fluid compartments can now be assessed with MR diffusion imaging. More slowly diffusing protons in ischemic tissues can be differentiated from normal parenchyma, CSF, and flowing blood, enabling the detection and localization of ischemic regions within minutes of the onset of stroke. Perfusion imaging "snapshots," obtained in as little as 25 msec with echoplanar MR methods, permit the evaluation of tissue washin/washout kinetics of contrast agents in the microvasculature, and thus the quantification of brain perfusion on a regional basis. Also, delineation of major intra- and extracranial arterial and venous structures with MR angiography, acquired with two- or three-dimensional Fourier transformation techniques, has enabled accurate noninvasive assessments of vascular occlusive disease. Finally, improvements in MR spectroscopic techniques have facilitated investigations of metabolic regulation and bioenergetics in experimental animal models of cerebral ischemia, as well as in stroke patients. Combined MR imaging and spectroscopy will likely play an important role in differentiating reversibly from irreversibly ischemic brain tissues and in the investigation of various neuroprotective pharmaceuticals.
The mermaid malformation: cloacal exstrophy and occult spinal dysraphism. Five infants with cloacal exstrophy underwent neurological evaluation and radiographic examination of the caudal spine shortly after birth. Each was found to have occult spinal dysraphism. Four had terminal myelocystoceles, and one had a lipomyelomeningocele. Pathological anatomy was confirmed during surgery for the release of the tethered spinal cords. The striking association between cloacal exstrophy and occult spinal dysraphism suggests a common developmental defect in the caudal pole of the embryo. A hypothesis is offered to explain this association. Terminal myelocystocele and lipomyelomeningocele appear to be part of a continuum of lesions associated with skin-covered spina bifida.
Enhancement of the protective qualities of gastric mucus by sucralfate: role of phosphoinositides. The effects of intragastric administration of sucralfate on the physicochemical properties of gastric mucus, and the mechanism of its protective action against alcohol-induced mucosal injury were investigated using in vivo and in vitro models. The experiments in vivo were conducted with groups of rats receiving a dose of 100 mg sucralfate twice daily for 5 consecutive days. The animals were sacrificed 16 hours after the last dose, their stomachs dissected, and the mucosa subjected to physicochemical measurements. In the in vitro studies, gastric mucosa was cultured in the presence of sucralfate, ethanol, or both. The in vivo results revealed that sucralfate elicited an 8% increase in mucus gel dimension, while its sulfo- and sialomucin content increased by 63% and 81%, respectively. The changes in mucus gel mucin content with sucralfate were accompanied by a 9.5% increase in mucus hydrogen ion (H+) retardation capacity, 1.9-fold increase in viscosity, and a 60% increase in the gel hydrophobicity. The mucus elaborated in the presence of sucralfate exhibited 14% lower protein content and 62% higher content of carbohydrate than that of control, and contained more neutral lipids. Furthermore, the gastric mucus of the sucralfate group showed a marked increase in mucus glycoprotein polymeric form. The data obtained with gastric mucosal culture demonstrated that sucralfate elicited a significant increase in mucin synthesis, which was reflected in the enhanced metabolism of mucosal phosphoinositides. In contrast, ethanol, which exhibited detrimental effects on mucin synthesis, also caused alterations in the phosphoinositide signal pathway. The changes in mucin and phosphoinositide distribution patterns evoked by ethanol were prevented by sucralfate. Our results suggest that the mucosal strengthening action of sucralfate occurs through the stimulation of the metabolism of phosphoinositide-derived messenger molecules.
The treatment of multiple intracranial tuberculous abscesses: a case report. A Chinese female aged 2 years 8 months with tuberculous meningitis developed hydrocephalus requiring insertion of a ventriculoperitoneal shunt. After adequate anti-tuberculosis chemotherapy for 14 weeks, multiple intracranial tuberculous abscesses developed. The lesions increased in size and number accompanied by clinical deterioration. Repeated drainage operations were performed in view of the increased intracranial pressure. The child made a remarkable recovery after an initial stormy course.
Clinical and pharmacokinetic basis for the antimicrobial treatment of acute otitis media. Given the astonishing frequency in childhood of acute otitis media and its significant morbidity, such as hearing loss and possibly speech delay, improving treatment of response is essential. Since bacteria are an important cause of otitis media, antimicrobial treatment remains the cornerstone of such treatment. Over the last four decades, many clinical studies have shown that antibiotics can relieve symptoms and prevalent complications, although a universal cure is still elusive. This article summarizes the most pertinent clinical and experimental research on treating and preventing acute otitis media, with a focus on intervention trials and the pharmacokinetic behavior of antimicrobial drugs.
Calcium-regulating hormones in hypertension: vascular actions. The vascular and potentially hypertensive actions of the calcium-regulating hormones 1,25-dihydroxychole-calciferol [1,25(OH)2D3], parathyroid hormone (PTH), and calcitonin and related factors such as parathyroid hypertensive factor (PHF) and calcitonin gene-related peptide (CGRP) are discussed. 1,25(OH)2D3 has inotropic and calciotropic actions on isolated vascular tissue whereas PTH is a vasodilator. PHF, which has been reported in plasma of humans with essential hypertension and spontaneously hypertensive rats, has both pressor and calciotropic actions. Calcitonin is without vascular effects and CGRP is a potent vasodilator. It is concluded that several of the hormones responsible for maintaining Ca2+ homeostasis modulate vascular Ca2+ metabolism and force generating capacity. These substances may be long-term modulators of vascular function and play a role in the determination of peripheral vascular resistance.
Are vascular abnormalities a primary cause or secondary consequence of hypertension? This paper reviews the evidence that the resistance vasculature is altered in hypertension and the role that the vasculature may play in the pathogenesis of the disease. Although functional changes (i.e., increased vascular smooth muscle sensitivity) have been found to be associated with some models of hypertension (e.g., spontaneously hypertensive rat), in human essential hypertension it appears that the abnormalities that predominate in the resistance vasculature are structural in nature. These changes result in an increased media/lumen ratio of the more proximal resistance vessels (i.d. 100-300 microns), and the changes are such that they could account for many of the altered hemodynamic characteristics seen in patients with essential hypertension (e.g., increased minimum vascular resistance, increased pressor response). However, evidence that the abnormal structure of the peripheral vasculature is a prime determinant of blood pressure is still lacking, and much of the available evidence suggests that the altered structure is a secondary adaptation. Nevertheless, the abnormal vascular structure may play an important pathological role concerning the morbid consequences of the hypertensive disease, suggesting that normalization of vascular structure is a desirable aim for antihypertensive treatment. At present it seems that treatment must be continued for long periods, maybe many years, before vascular structure is normalized.
The role of radiosurgery in the management of chordoma and chondrosarcoma of the cranial base. Despite conventional multimodality treatment (surgery and fractionated radiation therapy), recurrence and clinical progression of cranial base chordomas and chondrosarcomas are common. The malignant behavior of these tumors is a result of their critical location, locally aggressive nature, and high recurrence rate. To explore the role of radiosurgery in the treatment of these skull base neoplasms, we assessed its use in four patients with chordoma and two with chondrosarcoma. In five of the patients, radiosurgery was used as adjuvant therapy for residual or recurrent tumors after surgical debulking, and in one patient with a chordoma, it was the primary treatment. No patient received fractionated external beam radiotherapy. All tumors were less than 30 mm in diameter and were treated with 20 Gy to the tumor margin. Skull base computed tomography and magnetic resonance images were essential to define the anatomic relationships between tumor and adjacent basal structures. During follow-up (mean, 22 mo; range, 8-36 mo), we found no progression of the treated tumor volume in any patient. Neurological deficits before treatment improved in three patients; the other three patients remained in stable neurological condition. Serial follow-up imaging studies demonstrated that two patients showed reduction in tumor size and four patients had no tumor growth. In one patient, a metastatic parietal lobe chondrosarcoma developed and was treated by microsurgery. Another patient showed tumor progression outside of the radiosurgical treatment volume. Our results attest to the value of stereotactic radiosurgery as an adjuvant or primary treatment for selected patients with chordoma or chondrosarcoma and demonstrate its potential advantages over standard fractionated irradiation. Analysis of the long-term clinical and imaging effects after radiosurgery is warranted.
Mesenteric vascular anatomy at CT: normal and abnormal appearances. The appearance of the mesenteric vessels on computed tomographic scans was evaluated in 187 patients to determine the variations in the anatomic relationships between the mesenteric vessels in normal patients, in patients with malrotation, and in patients with abdominal masses. In 166 patients (88.8%), a portion of the cranial segment of the superior mesenteric vein (SMV) was anterior and to the right of the superior mesenteric artery (SMA), although other normal configurations also occurred. A portion of the cranial segment of the SMV was directly anterior to the SMA in 15 patients (8.0%) and directly to the right of the SMA in 16 patients (8.6%). Of eight patients with complete inversion of the SMA and SMV, one had normal midgut rotation, two had malrotation, and six had neoplasms that displaced the vessels (one of these six also had malrotation). Of eight patients with inversion of only a part of the mesenteric vessels, none had malrotation. Although mesenteric inversion should stimulate a careful evaluation for malrotation, it is not pathognomonic of this condition.
Suppression of gastric acid secretion by intravenous administration of famotidine in children. This study was designed to establish appropriate dosing requirements for intravenous use of famotidine, a new H2-receptor antagonist, in pediatric patients. Eighteen children, 2 to 69 months of age (mean +/- SD: 31 +/- 23 months), were treated with intravenously administered famotidine to prevent bleeding of the upper gastrointestinal tract. Continuous intragastric pH monitoring was carried out to ascertain the effectiveness of various intravenous doses. An initial dose of 0.4 mg/kg was given and repeated only after the intragastric pH had dropped to less than 4.0 for 2 hours. Increased doses were given (0.8, 1.2, and 1.6 mg/kg) if the previous dose did not raise the intragastric pH to greater than 4.0 for greater than or equal to 6 hours. Sixteen patients achieved an intragastric pH greater than or equal to 4.0 for greater than or equal to 6 hours, 13 with a dose of 0.4 mg/kg, and three with a dose of 0.8 mg/kg. The mean duration of continuous pH greater than 4.0 per dose was 9.0 +/- 7.5 hours. Ten patients received two or more intravenous doses of famotidine; the mean duration of pH greater than 4.0 after the second dose was less than that after the first (14.9 +/- 8.0 hours vs 6.9 +/- 3.2 hours, p less than 0.01). We conclude that intravenous famotidine therapy raises gastric pH to greater than 4.0 for approximately 9 hours in most children. Prolonged intravenous use of famotidine rapidly leads to a decreased duration of efficacy, necessitating intragastric pH monitoring to assess the effectiveness of treatment.
Regional cerebral blood flow imaging: a quantitative comparison of technetium-99m-HMPAO SPECT with C15O2 PET. The aim of this study was to compare technetium-99m-hexamethylpropyleneamineoxime (99mTc-HMPAO) single-photon emission computed tomography (SPECT) with regional cerebral blood flow (rCBF) imaging using positron emission tomography (PET). As investigation of dementia is likely to be one of the main uses of routine rCBF imaging, 18 demented patients were imaged with both techniques. The PET data were compared quantitatively with three versions of the SPECT data. These were, first, data normalized to the SPECT cerebellar uptake, second, data linearly corrected using the PET cerebellar value and, finally, data Lassen corrected for washout from the high flow areas. Both the linearly-corrected (r = 0.81) and the Lassen-corrected (r = 0.79) HMPAO SPECT data showed good correlation with the PET rCBF data. The relationship between the normalized HMPAO SPECT data and the PET data was nonlinear. It is not yet possible to obtain rCBF values in absolute units from HMPAO SPECT without knowledge of the true rCBF in one reference region for each patient.
Seasonality in sudden infant death syndrome--United States, 1980-1987. Sudden infant death syndrome (SIDS) is the sudden death of an infant less than 1 year of age that remains unexplained after a complete postmortem investigation, including autopsy, examination of the death scene, and review of the case history. SIDS, which usually occurs during sleep, is the leading cause of death in the postneonatal period (i.e., from 28 days through 364 days) and the eighth leading cause of years of potential life lost in the United States (1). The risk for SIDS is greatest for infants aged 1-4 months and during the cold season of the year (2); however, an independent contribution of the season of birth to the etiology of SIDS has not been consistently demonstrated (3). This report summarizes an assessment of the association between the risk for SIDS and an infant's month of birth, month of death, and age at death.
Endocardial fibroelastosis in infants with hydrops fetalis. Endocardial fibroelastosis, defined as an endocardium in excess of 30 microns thick, was found in 10 out of 34 cases of hydrops fetalis in a review of 1589 perinatal necropsies carried out between 1976 and 1989. The infants comprised 16 cases of rhesus haemolytic disease, of whom three had endocardial fibroelastosis, and 18 cases of non-rhesus hydrops, of whom seven had endocardial fibroelastosis. Intrauterine congestive heart failure was thought to have been the probable cause of hydrops in eight of the 10 infants with endocardial fibroelastosis. None of an age matched control group without endocardial fibroelastosis had evidence of congestive cardiac failure. These observations support the hypothesis that endocardial fibroelastosis is an endocardial response to chronic prenatal myocardial stress.
Colon perforation during colonoscopy: surgical versus conservative management. A survey of endoscopy units in the West Midlands, UK, was undertaken to ascertain the management of colonic perforation during colonoscopy. Fifteen perforations were reported from a total of 17,500 colonoscopies performed in 14 units (a rate of 0.09 per cent). In seven patients the diagnosis was suspected or diagnosed immediately and in the remaining eight 2-72 h later. Four patients with associated pathology (carcinoma, Crohn's disease, ulcerative colitis and a polyp) had resection and primary anastomosis. Seven patients had a simple oversew, four of these having had a delayed diagnosis. In four cases the site of perforation was not identified, but only one patient had conservative treatment. Three patients had drainage and a defunctioning colostomy. There was no significant morbidity following treatment. It is recommended that patients who have had a good bowel preparation should be treated conservatively unless there is a large perforation or an underlying carcinoma.
Health maintenance strategies for women of different ages. An overview. Preventive health strategies for screening for specific illnesses, counseling, and immunization are discussed. Emphasis is given to cardiovascular screening and risk reduction, screening for malignancies, and immunization practices. A framework for designing periodic health examinations for patients is detailed.
Tumor antigen presentation by murine epidermal cells. The ability of epidermal Langerhans cells to present Ag for CD4-dependent immunity is well documented, and it has been hypothesized that Langerhans cells participate in the generation of immunity against incipient epidermal neoplasms by presentation of tumor-associated Ag in situ. This study examined the ability of murine epidermal cells (EC) to present tumor-associated Ag for the induction of in vivo antitumor immunity. Murine epidermal cells were deleted of Thy-1-bearing cells, cultured in 50 U/ml granulocyte-macrophage-CSF for 14 to 18 h, and pulsed with tumor fragments (TF) derived from S1509a-fibrosarcoma cells. These TF-pulsed EC were injected s.c. into syngeneic recipients at weekly intervals for a total of three immunizations and challenged with viable S1509a tumor cells 1 wk after the last immunization. Control animals received TF-pulsed allogeneic EC or EC treated identically but not pulsed with TF. EC that were pulsed with tumor cell fragments were able to induce protective immunity to tumor growth in vivo and to immunize for a significant delayed-type hypersensitivity response to injected tumor cells. The induction of antitumor immunity with TF-pulsed EC was genetically restricted, and culture of EC in granulocyte-macrophage-CSF was required for development of significant immunity. Furthermore, deletion of I-A+ cells by antibody and complement-mediated lysis eliminated the generation of immunity. Thus, I-A+ epidermal cells are capable of presenting S1509a tumor Ag for the generation of protective antitumor immunity in vivo.