shukoor65/lab-rag-model huggingface dataset:
Selection criteria for successful immediate breast reconstruction. To evaluate the factors leading to success in immediate breast reconstruction after mastectomy, 176 consecutive immediate reconstructions done with implants or expanders over a 5-year period were analyzed. None of these 176 had "complete muscle coverage." There were only five failures: four with implant loss (one involving radiation) and one removed electively. The failures were 1 in 40 regular implants, 4 in 77 temporary expanders, and 0 in 59 long-term expanders. There is no other report in the literature comparing these different types of implants. Various hypotheses for failure are reviewed. It is concluded that failure in immediate reconstruction is not related to use of drains, bilaterality, or lack of "complete muscle coverage." It is concluded that failure is related to implant type, prior radiation, and most of all to suboptimal patient selection. Specific selection criteria and operative techniques are discussed.
Role of anteroventral third ventricle and vasopressin in renal response to stress in borderline hypertensive rats. The borderline hypertensive rat is the first filial offspring of the spontaneously hypertensive rat and the Wistar-Kyoto rat. In response to acute environmental stress (air jet), the borderline hypertensive rat exhibits a diuretic response, whereas the parental strains exhibit an antidiuretic response (spontaneously hypertensive rat) or no change in urine flow rate (Wistar-Kyoto rat). This study sought to investigate the role of the periventricular tissue surrounding the anteroventral third ventricle and vasopressin release in the diuretic response of the borderline hypertensive rat to acute environmental stress. Sixteen-week-old borderline hypertensive rats who had consumed a 1% NaCl diet for 10-12 weeks were given either electrolytic lesions of the anteroventral portion of the third ventricle or sham lesions. When exposed to acute environmental stress 4 weeks later, the increase in volume of dilute urine seen in the sham-lesion rats was not observed in the lesion rats. Plasma vasopressin concentration was decreased by acute environmental stress in the sham-lesion rats (15.2 +/- 4.0 to 10.9 +/- 1.7 pg/ml, p less than 0.05) but was unchanged in the lesion rats (12.3 +/- 2.0 to 13.4 +/- 4.0 pg/ml). In a separate group of intact borderline hypertensive rats, a constant intravenous infusion of vasopressin prevented the diuretic response to acute environmental stress. The results suggest that acute environmental stress produces a diuresis in the borderline hypertensive rats via a decrease in plasma vasopressin concentration that is dependent on the integrity of the periventricular tissue of the anteroventral portion of the third ventricle.
Inspiratory muscle dysfunction and chronic hypercapnia in chronic obstructive pulmonary disease A prospective evaluation of the prevalence of CO2 retention and its relationship to lung mechanics and inspiratory muscle strength was carried out in 311 clinically stable patients with chronic obstructive pulmonary disease (COPD). Of these patients 32.8% had hypercapnia (PaCO2 greater than or equal to 43 mm Hg). PaCO2 was directly related to lung resistance (RL; r = 0.53) and inversely related to FEV1 (r = 0.53) and to an expression of the dead space/tidal volume ratio (1 - VD/VT) (r = 0.48). RL was found to be a major determinant of the mean intrathoracic pressure swing developed during inspiration (PI) at rest (r = 0.85). Maximal inspiratory pressure (PImax) was found to improve the predictive value for PaCO2 of several mechanical loads, with RL/PImax the best predictor (r = 0.57). The prevalence of hypercapnia increased from virtually 0 to 100% with increases in the RL/PImax value and was higher in the obese subjects at intermediate RL/PImax values, probably because of the burden placed on the respiratory muscles by chest wall mass loading. Our results show that chronic alveolar hypoventilation is likely to develop in COPD patients who have a combination of high inspiratory loads and inspiratory muscle weakness. hypercapnia may be one strategy available to avoid overloading of the inspiratory muscles leading to fatigue and possible irreversible failure.
Evaluation of light microscopy to localise the site of haematuria. Red cell morphology was examined by light microscopy in 122 urine specimens from 99 patients with haematuria in an attempt to define the site of origin. Altogether 84% of glomerular bleeding and 91% of non-glomerular bleeding was correctly assigned according to diagnoses determined by renal biopsy in 51 patients and clinically in 48. The test should be interpreted with caution as both false positive and false negative results were observed, some in the same individual with unchanged pathology at different times. No advantage of phase contrast over bright field microscopy was apparent even when examining uncentrifuged urines.
Relative predispositional effects (RPEs) of marker alleles with disease: HLA-DR alleles and Graves disease. A method is described to reveal the relative predispositional effects (RPEs) (predisposing, protective, or neutral) of the HLA alleles or of any other marker system that is associated with a disease. When the disease is associated with two or more alleles of a locus, the RPE method identifies the associations sequentially according to their strength; thus the problem that a strong association with one allele can create misleading deviations in the frequencies of other alleles is alleviated. Using this method, we have examined the relative effects of HLA-DR alleles in susceptibility to Graves disease in the Caucasian population. The well-established positive association with DR3 was confirmed as the strongest effect. In addition, a negative association was found between DR5 and Graves disease. The reduced frequency of DR5 among patients is statistically significant and is not a result of the increase in DR3. Finally, when patients were divided according to the presence or absence of eye disease, the latter showed a significant increase in the frequency of DR4. With family data, linkage to HLA of Graves disease was established in both Caucasian and Chinese families by the sib-pair method.
Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii BACKGROUND. Helicobacter pylori are gram-negative spiral bacteria that are associated with chronic gastritis, a known precursor of gastric carcinoma. Persons at high risk for gastric carcinoma have been shown to have a high prevalence of H. pylori infection. METHODS. We studied the relation of H. pylori infection and gastric carcinoma in a cohort of Japanese American men living in Hawaii. The 5908 men were enrolled and examined from 1967 to 1970. By 1989, 109 cases of pathologically confirmed gastric carcinoma had been identified. The store serum of each patient with gastric carcinoma and of each matched control subject were tested for the presence of serum IgG antibody to H. pylori. RESULTS. Ninety-four percent of the men with gastric carcinoma and 76 percent of the matched control subjects had a positive test for H. pylori antibodies, for an odds ratio of 6.0 (95 percent confidence interval, 2.1 to 17.3). As the level of antibody to H. pylori increased, there was a progressive increase in the risk of gastric carcinoma (P for trend = 0.0009). The association was strong even for men in whom the diagnosis was made 10 or more years after the serum sample was obtained (odds ratio, 10.5; 95 percent confidence interval, 2.5 to 44.8). CONCLUSIONS. Infection with H. pylori is strongly associated with an increased risk of gastric carcinoma. However, most persons infected with H. pylori will never have gastric carcinoma. Therefore, other factors that increase the risk of gastric carcinoma among persons infected with H. pylori need to be identified.
Intracranial vascular abnormalities: value of MR phase imaging to distinguish thrombus from flowing blood. The interpretation of conventional spin-echo and gradient-echo MR images of intracranial vascular lesions can be complex and ambiguous owing to variable effects on image intensity caused by flowing blood or thrombus. MR phase images, obtained simultaneously with conventional-magnitude images, are useful for evaluating proton motion (i.e., blood flow), and therefore can simplify the diagnosis of the presence or absence of thrombosis within a vascular structure or lesion. Fourteen patients with a variety of intracranial vascular abnormalities (aneurysms, superior sagittal sinus thrombosis, neoplasms adjacent to venous sinuses, and vascular malformations) were evaluated with conventional MR and phase imaging for the presence of blood flow. The phase images correlated with angiography in all cases. Phase imaging was not necessarily better than conventional spin-echo imaging in all cases, but it simplified the evaluation of thrombus vs blood flow in many. In three of five aneurysms, the phase images were diagnostic for evaluating lumen patency whereas the conventional images were ambiguous. Phase imaging was advantageous for detecting tumor invasion of the venous sinus when venous blood was enhanced by gadopentetate dimeglumine. A laminar flow phantom experiment determined the lower limits of sensitivity of phase imaging to be 0.5 cm/sec in the slice-select and 2.5 cm/sec in the read gradient directions. Phase imaging is a simple, reliable technique that can distinguish thrombosis from flowing blood within intracranial lesions. It is easily performed and adds no additional time to the MR examination.
A behavioral taxonomy of obese female participants in a weight-loss program. To create a behavioral classification of obesity, 2-wk baseline food diaries were obtained from 236 obese women entering weight-loss programs. Subjects monitored food intake along with the social, environmental, and emotional context in which each meal occurred. Variables representing situation-specific eating behaviors were statistically extracted from greater than 11,000 eating episodes. Hierarchical cluster analysis identified five distinct groups of subjects on the basis of similarity of eating patterns. The five groups were (1) moderately healthy eating habits, (2) chronic food restrictors, (3) alternating diet-binge eaters, (4) emotional overeaters, (5) unrestricted meal overeaters. The five groups differed on questionnaire measures of emotional adjustment and eating behavior but did not differ on dropout rates, amount of weight lost, or exercise compliance. The chronic food restrictors had significantly less lean body mass, lower resting metabolic rates, and higher waist-to-hip ratios than did the unrestricted meal overeaters.
Economic impact of diagnosis-related groups and severity of illness on reimbursement for central nervous system infections. Because the federal government's diagnosis-related group (DRG) classification system for prospective payment has not been widely applied to hospitalized pediatric patients, we analyzed the effectiveness of one DRG category (central nervous system infections) for a single year at a medium-sized children's hospital to control for patients' severity of illness and for hospital reimbursement. Several independent measures of severity of illness (length of stay, duration of fever, Physiologic Severity Index) showed that patients with bacterial meningitis and those with encephalitis (DRG 20) were more ill than those with aseptic meningitis (DRG 21) (p less than 0.001 for each measure). Cost analysis revealed that the hospital was only partially reimbursed for its charges (shortfall of $95,547) and that patients with Medicaid or no insurance accounted for 22% of discharges but 88% of losses. Reimbursement by DRG would have increased payment for DRG 21 but decreased that for DRG 20. If DRGs were applied to pediatric central nervous system infections and used in a prospective payment system, they would accurately predict disease severity between but not within groups, and significant financial losses for children's hospitals would still occur.
Acute thrombosis of the renal transplant artery: a case report and review of the literature. Acute thrombosis of the renal transplant artery is a known but unusual complication of renal transplantation usually occurring in the first month. Reported here is a case of acute renal artery thrombosis in a well functioning long-term renal allograft in which there was clear angiographic evidence of a normal renal artery two years earlier.
Peripheral mucoepidermoid tumour of the lung. Mucoepidermoid tumours of the bronchial tree are uncommon neoplasms, which are believed to arise from terminal ducts of the proximal tracheobronchial tree. The first case of a peripheral mucoepidermoid tumour of the lung is reported.
Efficacy of danazol in the control of hormonal migraine. Of 131 women with hormonally related migraines unresponsive to standard medication, 67 (51.1%) noted profound relief after a 12-month, phased study using danazol for migraine prevention. The first three phases consisted of two-month cycles: dietary control and acetazolamide, the addition of danazol and danazol discontinuation. Eighty-three women (63.36%) reported control of their hormonal migraines while using danazol. In phase IV, 81 women whose headaches were controlled by danazol restarted danazol for an additional six months. Sixty-seven (82.7%) reported continued success with this medication. Danazol proved highly successful in the control of women's cyclic migraine. Its effectiveness remained consistent throughout the treatment course. In the prophylactic treatment of women's hormonal migraine, 400 mg of danazol administered daily for 25 days each month can prove effective when standard medical therapy fails. Furthermore, the response to danazol supported the concept that hormonal migraine should be treated as a distinct clinical entity.
Orientation and moment arms of some trunk muscles. The orientations and moment arms of nine trunk muscles: latissimus dorsi, iliocostalis, longissimus dorsi, obliquii, rectus and transversalis abdominis, quadratus lumborum, and iliopsoas were obtained on embalmed specimens. Each muscle was considered as one or several, linear or curvilinear, lines of action. Origins, insertions, and points along the length of main bundles were digitized for each muscle using a three-dimensional digitizer. The results obtained from seven male specimens are presented and will permit more refined biomechanical models.
Prophylaxis of nasolacrimal duct obstruction after major sinus surgery using a silicone stent. Damage to the nasolacrimal duct during major sinus procedures results in troublesome symptoms of epiphora and acute infection. Prophylactic stenting of the lacrimal apparatus using a silicone stent is described as a means of preventing such complications.
Renal disease, epidermal necrosis, and epithelial cell antibodies. OBJECTIVE--To describe the association between epithelial cell IgM, which has previously been associated with an increased incidence of loss of renal graft in children, with a novel cutaneous eruption and unexplained native renal disease. DESIGN--Observational study on children with epithelial cell antibody presenting with unexplained renal or skin disease. SETTING--General paediatric department and regional paediatric nephrology unit. PATIENTS--Six children (five girls, one boy), who presented to the unit in 1989-90. RESULTS--Three children, two of whom had a history of a hyperpigmented rash, presented with hypertension, proteinuria, and impaired renal function. Renal biopsy specimens from two of these children showed severe arteriolar endothelial cell swelling with arteriolar occlusion. These children fully recovered after treatment with antihypertensive drugs. The third child developed end stage renal failure and required dialysis. Three other children presented with an unusual cutaneous eruption but no evidence of renal disease. Histology of the skin lesions showed acute epidermal necrosis and features consistent with a viral infection. CONCLUSIONS--The aetiology and pathogenesis of the epithelial cell antibody are unknown. These cases indicate that it may have a role in native kidney disease and focal epidermal necrosis. Clinical and histological features suggest that the antibody may be associated with a viral infection.
Placement of an ileal loop urinary diversion back in continuity with the intestinal tract. The use of ileum from a previously constructed urinary conduit for lengthening the small bowel has not been previously reported. We describe a patient with the short-bowel syndrome from previous small-bowel resections, radiation enteritis, and an ileal urinary diversion. The ileal conduit was revised because of recurrent hyperammonemic encephalopathy and apparent stricture of the ureteroenteric anastomosis. In an attempt to increase intestinal length, the ileal conduit was replaced by a colon conduit and the ileum was placed back in continuity with the intestinal tract. The patient had an uneventful recovery, and her chronic diarrhea, nutritional deficiencies, and metabolic derangements resolved. The ileal loop segment regained a normal intestinal appearance on radiographic studies. We suggest that when revision of an ileal urinary diversion is required restoration of the ileum into the intestinal tract may be of particular benefit to patients with the short-bowel syndrome.
Screening for unruptured asymptomatic intracranial aneurysms in patients undergoing coronary angiography. In screening for unruptured asymptomatic intracranial aneurysms, an intracranial intra-arterial digital subtraction angiography (IA-DSA), posteroanterior view, was obtained in 72 consecutive patients who underwent coronary angiography for workup of angina pectoris. In cases where an aneurysm was suspected from IA-DSA, conventional intracranial angiography was obtained. Five asymptomatic unruptured aneurysms were detected in four of these cases. The aneurysms ranged from 4 to 16 mm in diameter. There were no complications associated with the coronary angiography nor with the additional intracranial IA-DSA, which required less than 5 minutes to perform in all cases. The value of performing intracranial IA-DSA in patients undergoing coronary angiography to screen for unruptured asymptomatic aneurysm is discussed, as is the possible racial differences in the frequency of aneurysms.
Effect of omeprazole on duodenal ulcer-associated antral gastritis and Helicobacter pylori. This study set out to investigate the effects of omeprazole or ranitidine on the progression of antral gastritis and Helicobacter pylori in patients with active duodenal ulcer. A double-blind, double-dummy trial was performed in 270 patients, 241 of whom were studied histologically for the presence of H. pylori. Patients were randomized to receive omeprazole, 10 mg every morning, omeprazole, 20 mg every morning, or ranitidine, 150 mg twice a day, for four weeks. Endoscopy was performed on entry and at weekly intervals during the study; at least two antral biopsies were taken on each occasion to assess the activity and degree of chronic inflammation, as reflected by the degree of polymorphonuclear leukocyte infiltration and mononuclear cell infiltration, respectively. Biopsy specimens also were assessed histologically for H. pylori. The sex, age and maximal acid output were comparable in the three treatment groups. The percentages of patients showing an improvement in the activity of gastritis in the four consecutive weeks of treatment were 9%, 40%, 51%, and 53% for omeprazole, 10 mg (N = 78); 14%, 42%, 49%, and 53% for omeprazole, 20 mg (N = 81); and 2%, 23%, 30%, and 33% for ranitidine, 150 mg twice a day (N = 82) (life table analysis gave P less than 0.01 for both omeprazole regimens compared with ranitidine). The degree of chronic inflammation showed similar changes. The density of H. pylori decreased significantly after treatment with omeprazole, 10 mg or 20 mg, (both, P less than 0.00001) but not with ranitidine.
Amplified expression of three jun family members inhibits erythroleukemia differentiation. Several different proto-oncogenes have been shown to influence cellular differentiation. One of the most widely studied model systems has been the Friend murine erythroleukemia cell (F-MELC) line, which can be induced to undergo erythroid differentiation by a variety of chemical agents. Constitutive overexpression of either the c-myc or c-myb proto-oncogenes has been previously shown to inhibit F-MELC differentiation, whereas c-myc antisense sequences accelerate the process. To investigate the potential involvement of other proto-oncogenes and immediate early response genes in F-MELC differentiation, we studied the expression of the three known members of the jun family as well as another gene, egr-1, which, like the jun family members, is expressed as an immediate early response gene in growth factor-stimulated quiescent cells. All four genes were expressed in F-MELC, although the levels of expression and modes of regulation differed. Transfection with amplifiable c-jun, junB, or junD expression plasmids inhibited differentiation, whereas transfection with an egr-1 expression plasmid was without effect. These results indicate that jun family members play a role in mediating F-MELC differentiation. The known inhibitory effect of phorbol ester tumor promoters on F-MELC differentiation may be the result of their known stimulation of jun expression.
Histological study of white blood cells and their association with lipodermatosclerosis and venous ulceration. The number of white blood cells per mm2 has been determined in serial histological slides taken from punch biopsies of skin from the goiter region in patients with varicose veins. In eight patients the varicose veins were complicated by lipodermatosclerosis of the skin, and in a further six there was a history of ulceration. In uncomplicated varicose veins there was a median of 6 white blood cells per mm2, in patients with lipodermatosclerosis there were 45 white blood cells per mm2, and where there was a history of ulceration, 217 white blood cells per mm2. No change in white blood cell content was observed after the venous pressure was raised for 30 min by sitting the patient with the lower limb dependent. White blood cell infiltration of the skin is associated with lipodermatosclerotic changes caused by venous insufficiency.
Fatal varicella in an adult: case report and review of the gastrointestinal complications of chickenpox. An unusual and fatal case of primary varicella in an adult is presented. Involvement of the small intestine first manifested as abdominal pain and later progressed to gastrointestinal bleeding with subsequent dissemination of the infection. Although it has previously been speculated that gastrointestinal bleeding can result from infection with the varicella-zoster virus, the data from this case include histologic and cultural evidence that supports the clinical observations. The literature has been reviewed, and the management of this patient has been critically evaluated.
Detection of human T-cell leukemia virus type I proviral sequences from fixed tissues of seropositive patients. Fixed lymphoma tissues from 11 patients seropositive for human T-cell leukemia virus type I (HTLV-I) antibodies were analyzed for proviral sequences by the polymerase chain reaction. Typical adult T-cell leukemia/lymphomas (ATLLs) from nine patients were positive for HTLV-I sequences. In contrast, one of two lymphomas with immunophenotypes atypical for ATLL was negative for HTLV-I. This HTLV-I DNA-negative lymphoma, although present in an HTLV-I-seropositive patient, was therefore reclassified. The HTLV-I tax gene was always detected in the ATLL tissues, whereas segments of the pol gene were not detected in half the cases. These studies demonstrate that fixed non-ATLL specimens can be distinguished from ATLL specimens.