shukoor65/lab-rag-model huggingface dataset:
Importance of RAA system and the treatment of patients with ACE inhibition after myocardial infarction. There is activation of the renin angiotensin system after both complicated and uncomplicated myocardial infarction. Angiotensin II increases myocardial oxygen consumption whilst reducing coronary flow and is also directly toxic to the myocardium. Angiotensin converting enzyme inhibitors produce beneficial haemodynamic and neuroendocrine changes in patients with acute left ventricular failure, and may have a role in selected patients with cardiogenic shock. There is evidence to suggest that they might prevent the development of late cardiac failure by limiting the extent of post infarction ventricular dilation. Further research is necessary to define their role in the treatment of acute myocardial infarction.
Paraproteinemic corneal deposits in plasma cell myeloma. We treated two patients who had IgG-kappa-light chain monoclonal gammopathy with partially crystalline and partially amorphic corneal deposits. Impairment of vision made keratoplasty necessary for each patient. Histologic examination of the corneal specimens showed deposits that stained positively for Masson's trichrome in all corneal cells. Immunohistochemical tests identified these deposits as IgG-kappa-light chain immunoglobulin fragments. Electron microscopy showed intracellular, rhomboid-shaped deposits enveloped by a membrane. The same deposits appeared in the conjunctival epithelium, within subconjunctival fibrocytes, and in the plasma cells of the bone marrow. Immunoelectrophoresis showed IgG-kappa-light chain fragments in the blood serum, the lacrimal film, and the aqueous humor. This suggests that the intracellular immunoglobulin fragments may have entered the corneal and conjunctival epithelium by way of the lacrimal film, the keratocytes by way of the corneo-scleral limbus vasculature, and the endothelial cells from the aqueous humor.
The necessary length of hospital stay for chronic pulmonary disease. OBJECTIVE.--To determine the necessary length of stay for patients admitted to the hospital with an exacerbation of chronic pulmonary disease and to compare this with the length of stay assigned by the diagnosis related group system. DESIGN.--A cohort of patients were followed up prospectively after hospital admission to determine when complications, critical incidents, and the need for monitoring occurred. The medically derived necessary lengths of stay were statistically compared with the lengths of stay assigned by the diagnosis related group. Clinical factors were used to predict long vs short necessary lengths of stay. SETTING.--Two acute care hospitals: one was the principal and the other a major community teaching hospital. PATIENTS.--A consecutive sample of 83 patients who were 45 years of age or older and who required admission for treatment of chronic pulmonary disease. MAIN OUTCOME MEASURES.--The occurrence and time of complications, critical interventions, and monitoring. RESULTS.--After 6 days in the hospital, 90% of patients were free of complications or the need for monitoring. However, 16 days elapsed before 90% of patients had been discharged from the hospital. The length of stay that was considered necessary for care averaged 6.9 days; the actual mean length of stay was 8.7 days. The correlation between each patient's ideal length of stay and the length of stay assigned by the diagnosis related group was low and was not statistically significant. Three clinical variables at the time of admission (high PCO2 levels, symptoms that were present for more than 1 day, and antibiotic treatment) were associated with the need for longer hospital stays. CONCLUSIONS.--The medically required length of stay for patients with an exacerbation of chronic pulmonary disease was between 6 and 7 days, on average. This length of stay, which was based on clinical events, differs from the length of stay that was calculated as a statistical norm by the diagnosis related group system. Clinical characteristics may help to identify patients who require a longer length of stay.
Isoenzymes of alkaline phosphatase in epileptic patients receiving carbamazepine monotherapy. The effects of carbamazepine monotherapy were investigated in 20 female and 21 male epileptic patients to determine whether treatment would induce an increase in serum alkaline phosphatase (ALP) activity, a known effect of many anticonvulsant drugs. Serum total ALP activity was increased in nine out of the 41 patients (22%), serum bone ALP activity was increased in 10 (24%), and serum non-bone ALP activity was increased in three (7%). There was no significant difference when the mean of the patients' serum total ALP was compared with that of the controls. Twenty per cent of the patients with increased serum bone ALP had normal serum total ALP, indicating that increased serum bone isoenzyme activity may precede an increase in the total enzyme activity. This should be considered when interpreting results of increased total ALP in epileptic patients.
Adenocarcinoma of the prostate: biopsy to whole mount. Denver VA experience. Clinical understaging abounds in adenocarcinoma of the prostate. The preoperative prostate-specific antigen is not useful in preoperative staging, although enzymatic acid phosphatase elevation is associated with positive nodes in two-thirds of patients. Whole mount evaluation of radical prostatectomy specimens reveals tumor multicentricity in more than half the patients and tumor extension beyond the prostatic capsule in the majority of patients. A significant number of patients have a final tumor grade higher than that initially assigned. Capsule penetration by tumor is a factor of tumor grade as is volume.
Drug-induced esophagitis. Drug-induced esophagitis is being recognized increasingly in the past few years. We have reviewed 175 cases with a view to classifying this disease based on pathology. Drug-induced esophageal injury tends to occur at the anatomical site of narrowing, with the middle third behind the left atrium predominating. The disease is classified broadly into two groups. The first group is transient and self-limiting, as exemplified by tetracycline- and emepronium-induced injury (57.3%). The second is the persistent esophagitis group, often with stricture with two distinct entities: 1) patients on nonsteroidal antiinflammatory agents whose injury is aggravated by gastroesophageal reflux (26.2%) (reflux aggravated), and 2) patients with potassium chloride and quinidine sulfate-induced injury (16.2%) (persisting drug injury). We report a case that highlights the pathophysiology (delayed transit, persisting potassium within the stricture) of this type of injury which is not reflux aggravated.
Cervical human papillomavirus deoxyribonucleic acid and cytologic evaluations in gynecologic outpatients. We studied the prevalence and cytologic manifestations of human papillomavirus deoxyribonucleic acid among 2668 gynecologic outpatients. The study population consisted of 1573 women who came into the emergency room, 623 women from an abortion clinic who were seen because of induced first-trimester abortion, and 472 women who had been referred to a colposcopy clinic because of an abnormal Papanicolaou smear finding. A dot blot technique was used for the detection of human papillomavirus types 6/11, 16/18, and 31/33/35. The prevalence of human papillomavirus deoxyribonucleic acid was 4.4% in the emergency room population, 8.8% in the abortion clinic population, and 31.4% in the colposcopy clinic population. Human papillomavirus type 16/18 was most prevalent (3.5%), followed by human papillomavirus type 31/33/35 (3.1%), and human papillomavirus type 6/11 was least prevalent (2.1%). Of all unselected human papillomavirus deoxyribonucleic acid-positive women who were enrolled from the emergency room or from the abortion clinic, 73% had normal cytologic evaluations. Twenty-five percent had benign atypia, and 2% had dyskaryotic changes. No human papillomavirus deoxyribonucleic acid type-specific differences were detected in the distribution of cytologic atypias.
Clinicopathologic observations in essential tremor: report of six cases. Essential tremor (ET) is the most common pathologic tremor, but only eight cases have been studied pathologically. We report detailed clinical and neuropathologic studies of six additional patients. We did not find any neuropathologic lesions that might be specific for ET. Moreover, there were no abnormalities of the substantia nigra consistent with Parkinson's disease. The neuropathologic substrate of ET remains unknown.
Ossifying fibroma in the sylvian fissure: case report. A rare case of an ossifying fibroma that developed in the sylvian fissure is reported here. During surgery, branches of the middle cerebral artery were encased in osseous tumor. The encased branches were divided and reanastomosed after the mass was removed. Postoperative angiograms demonstrated patency of the anastomosed arteries and a postoperative magnetic resonance imaging scan revealed no infarction distal to the arterial anastomoses. The authors recommend division and anastomosis of the encased arteries rather than partial removal of tumor from around the encased arteries, resulting in residual tumor being left behind.
Changes in standard electrocardiographic ST-segment elevation predictive of successful reperfusion in acute myocardial infarction. The ability of the electrocardiographic ST segment to predict successful reperfusion after thrombolytic therapy remains controversial. To evaluate whether angiographically determined reperfusion could be predicted from changes in ST-segment elevation, the sum of ST-segment elevation in affected leads of the electrocardiogram was compared before and after thrombolytic therapy in 53 patients with acute myocardial infarction (AMI). Reperfusion status of the infarct-related artery was determined angiographically less than 8 hours from onset of symptoms. According to the Thrombolysis in Myocardial Infarction trial (TIMI) criteria, 33 patients had successful reperfusion (TIMI grade 2 to 3 flow) after thrombolytic therapy and 20 patients did not (TIMI grade 0 to 1 flow). Logistic multiple regression analysis showed that the proportional value for the shift in the sum of ST elevation, termed the "% ST change," was more strongly associated with reperfusion than the absolute measured difference in millimeters (chi-square = 11.34 vs 9.22). The entire spectra of sensitivities and specificities were determined to identify a level of the percent ST change with simultaneous high sensitivity and specificity. A 20% decrease in ST elevation provided such a level (88% sensitivity, 80% specificity). The positive and negative predictive values of a 20% decrease in ST elevation were 88 and 80%, respectively. These results suggest that a decrease of only 20% in the sum of ST elevation in the standard electrocardiogram after thrombolytic therapy is a useful noninvasive predictor of reperfusion status in patients with evolving AMI.
Treatment of posterior urethral strictures with a titanium urethral stent. A total of 5 patients with recurrent posterior urethral strictures underwent endoscopic placement of an expandable endourethral stent made of titanium. Patient age ranged from 17 to 66 years (mean age 42.6 years). Followup ranged from 13 to 20 months (mean 14.1 months). Of the patients 4 presently have unobstructed voiding with no incontinence. To date no side effects have been directly related to the stents and no incrustations or calculi have formed. Our preliminary study supports the use of titanium urethral stents as an alternative form of treatment for selected urethral strictures.
Haemopericardium and cardiac tamponade complicating pulmonary lymphangioleiomyomatosis. A case of pulmonary lymphangioleiomyomatosis complicated by haemopericardium and cardiac tamponade is reported. This was successfully managed by creating a subdiaphragmatic extraperitoneal window.
Feasibility of epidural morphine for postoperative analgesia in a small community hospital. The first 6-mo experience of a two-physician APS using primarily epidural morphine in a community hospital is presented. After-hours anesthesia coverage was from home. The only monitoring was by nursing service observation. Complications occurred at incidences comparable to larger studies. Using the precautions outlined in the text, complications were appropriately diagnosed and treated despite the lack of 24-h in-house anesthesia coverage.
Pain and impairment beliefs in chronic low back pain: validation of the Pain and Impairment Relationship Scale (PAIRS). Few validated instruments are available to assess beliefs and attitudes that patients have regarding pain, or ability to function despite discomfort. The Pain and Impairment Relationship Scale (PAIRS) was developed to tap these important beliefs and attitudes in chronic pain patients. Preliminary data indicate that the PAIRS is internally consistent and significantly related to impairment in a highly selected pain clinic sample of patients, including some chronic low back pain patients. The present study was designed to extend the validation of the PAIRS to a more general sample of chronic benign low back pain patients. Furthermore, additional tests supported the discriminant, convergent and divergent validity, as well as the reliability and relative independence from favorable self-report response bias of the PAIRS, by respectively demonstrating that: (1) the impairment beliefs assessed with the PAIRS were more prominent in chronic low back pain (CLBP) patients than in matched non-pain, healthy controls; (2) scores on the PAIRS were significantly related to measures of physical impairment, but not to physicians ratings of disease severity; (3) the impairment beliefs assessed with the PAIRS are readily distinguishable from cognitive distortions and emotional distress; (4) PAIRS scores for chronic low back pain patients are relatively consistent over time; and (5) PAIRS scores are not significantly associated with measures of favorable self-report response bias. We conclude that the PAIRS has demonstrated at least preliminary utility for applications by researchers and clinicians interested in chronic pain.
Confirmation of the efficacy of hepatic tissue iron index in differentiating genetic haemochromatosis from alcoholic liver disease complicated by alcoholic haemosiderosis. The hepatic tissue iron index proposed by Bassett et al was evaluated in 35 patients with homozygous genetic haemochromatosis, 67 patients with alcoholic liver disease, and 18 patients with other forms of chronic liver disease with and without cirrhosis. In patients with cirrhosis hepatic tissue iron concentration reliably differentiated alcoholic liver disease from genetic haemochromatosis. Although mean iron concentration was greater in patients with prefibrotic haemochromatosis than in those with prefibrotic alcoholic liver disease, some overlap occurred and complete differentiation of the two conditions was not possible. This overlap was particularly evident in some young patients with haemochromatosis in whom the tissue iron concentration grade fell in the range commonly seen in alcoholic haemosiderosis. Inability to differentiate early genetic haemochromatosis from alcoholic liver disease complicated by haemosiderosis was also a problem with standard Perls's staining. When the hepatic tissue iron index was calculated (hepatic tissue iron concentration/patient's age in years), clear differentiation of genetic haemochromatosis from both alcoholic liver disease and other forms of chronic liver disease was obtained in both cirrhotic and precirrhotic patients. This study confirms that the hepatic tissue iron index is a useful means of differentiating patients with genetic haemochromatosis from those with alcoholic liver disease. We suggest that biochemical estimation of tissue iron concentration and calculation of the tissue iron index in all patients in whom genetic haemochromatosis is a possible diagnosis will reduce the likelihood of misdiagnosing this as alcoholic liver disease.
Intralesional interferon gamma treatment for keloids and hypertrophic scars. Keloids and hypertrophic scars are characterized by excessive collagen formation. Interferon gamma is a lymphokine that can down-regulate collagen synthesis in vitro and in vivo and, therefore, has potential therapeutic benefit in the management of abnormal scars. Intralesional scar injections of interferon gamma were performed to determine the tolerance toxicity and to obtain preliminary evidence for the efficacy of this treatment in the management of hypertropic and keloid lesions. All scars decreased in linear dimensions and flattened out. Five of 10 scars studied decreased at least 50% in linear dimensions. Interferon gamma can safely be administered intralesionally once per week up to a dosage of 0.05 mg for 10 weeks with no serious toxic effects. The commonest reported side effect was a mild headache.
The relationship between autoantibodies and intrauterine growth retardation in hypertensive disorders of pregnancy. Abnormal levels of autoantibodies have recently been demonstrated in patients with hypertensive disorders of pregnancy and patients whose fetuses have intrauterine growth retardation. We determined total immunoglobulin levels (immunoglobulin G, immunoglobulin M, and immunoglobulin A) and a broad panel of autoantibodies (six antiphospholipid, four antihistone, and four antipolynucleotide antibodies) in 50 normotensive pregnant females, 19 patients with preeclampsia, and 18 patients with chronic hypertension to examine the relationship to intrauterine growth retardation. Mothers who were delivered of infants with intrauterine growth retardation demonstrated significantly more autoantibody abnormalities in the two hypertensive groups and in the normotensive control group as compared with patients delivered of appropriately grown infants. The most frequently observed autoantibody abnormalities were antiphospholipid antibodies and the most frequently observed among those were immunoglobulin G isotypes. Total immunoglobulin levels in both hypertensive and normotensive groups were identical. These results suggest a close association between the degree of B-cell activation and both severity of hypertensive diseases and development of intrauterine growth retardation in their offspring.
Emergency treatment with recombinant tissue plasminogen activator of pulmonary embolism in a pregnant woman with antithrombin III deficiency. Thromboembolic complications during pregnancy are frequent in patients with congenital antithrombin III deficiency. We report on a 29-year-old patient with congenital antithrombin III deficiency and severe pulmonary embolism treated with recombinant tissue plasminogen activator. The diagnosis of antithrombin deficiency is retrospective. This case indicates that the risk of thrombolytic therapy in this clinical setting might have been overemphasized.
Tobacco, alcohol, and coffee and cancer of the pancreas. A population-based, case-control study in Quebec, Canada. A population-based, case-control study of pancreatic cancer was carried out in greater Montreal between 1984 and 1988. A total of 179 cases and 239 population-based controls were interviewed. This study was part of the SEARCH program of the International Agency for Research on Cancer of the World Health Organization. A strong positive association was observed between total cigarette smoking and risk of pancreatic cancer (odds ratio [OR] = 3.76; 95% confidence interval [CI], 1.80 to 7.83). The OR for current smokers in the highest quintile of number of cigarettes was 5.15 compared with 3.99 for exsmokers. Those who consumed alcohol were in general at lower risk than nondrinkers. Coffee drinkers were collectively at lower risk than nondrinkers, particularly when coffee was consumed with meals, not on empty stomach.
Induction of T helper cell unresponsiveness to antigen by macrophages from schistosomal egg granulomas. A basis for immunomodulation in schistosomiasis? The present studies were undertaken in an effort to understand the role of mononuclear phagocytes in the regulation of the T cell-mediated granulomatous inflammatory response in experimental murine schistosomiasis mansoni. We report that macrophages from schistosomal egg granulomas did not efficiently stimulate, but rather induced marked proliferative unresponsiveness to Ag in an IL-2-producing, I-Ek-restricted, CD4+ Th cell clone specific for pigeon cytochrome c. The unresponsive state of the T cells was achieved after incubation with granuloma macrophages in the presence of the specific Ag fragment 81-104, but not with either of them independently, and was, similarly, restricted by the I-Ek molecule. Equivalent amounts of peritoneal macrophages from schistosome-infected, but not from normal mice, were also effective in inducing T cell unresponsiveness. We postulate that granuloma macrophages, and potentially other accessory cells in schistosome-infected individuals, are similarly capable of inducing anergy in egg Ag-specific Th cells, and that the resulting inhibited T cell reactivity, which translates into failure of lymphokine secretion and of clonal expansion, represents a major basis of the immunologic down-regulation (immunomodulation) of granulomatous hypersensitivity, characteristically seen in this disease.
Repression of the interferon signal transduction pathway by the adenovirus E1A oncogene. The signal transduction pathway initiated by type I interferon (alpha and beta interferons) is inhibited by expression of the adenovirus type 5 E1A oncogene. Cotransfection analyses with the E1A oncogene and an interferon-stimulated reporter gene show that mutations within an amino-terminal domain of the E1A oncoprotein are defective in transcriptional repression. Cotransfection experiments also revealed that the transcriptional repression is mediated through the interferon-stimulated response element (ISRE) found within the promoter of interferon-stimulated genes. Since interferon treatment activates a latent cytoplasmic DNA-binding factor that can recognize the ISRE and subsequently stimulate transcription, the appearance of this factor was analyzed in a cell line that constitutively expresses the E1A oncogene. The DNA binding activity of this transcriptional activator was found to be inhibited in the E1A-expressing cell line. In vitro cytoplasmic mixing experiments with extracts from control and E1A-expressing cells identified a specific component of this multimeric transcription factor to be defective.
Value and limitations of color Doppler echocardiography in the evaluation of percutaneous balloon mitral valvuloplasty for isolated mitral stenosis. The limitations of 2-dimensional and pulsed Doppler echocardiography in patients undergoing mitral valvuloplasty are well known. This study was undertaken to assess the value of color Doppler flow imaging in 36 symptomatic mitral stenosis patients who subsequently underwent successful balloon mitral valvuloplasty by comparing the results to those obtained at cardiac catheterization. Color Doppler-guided conventional Doppler assessment agreed well with cardiac catheterization results in classifying mitral stenosis as mild, moderately severe and severe, both before and after valvuloplasty. Color Doppler was also useful in identifying patients who had moderate to severe mitral regurgitation before and after valvuloplasty. Color Doppler flow mapping was more sensitive than oximetry in the detection of iatrogenic atrial septal defects, which were noted in 25 patients. The defects of those patients with smaller defects by color Doppler (diameter less than 0.7 cm) or echocardiographic shunt volume less than 0.7 liters/min tended to close, usually within 6 months, as opposed to those with larger defects or higher shunt volumes, which tended to persist. Echocardiographic shunt volumes revealed a fair correlation with oximetric results.