shukoor65/lab-rag-model huggingface dataset:
MSG and hydrolyzed vegetable protein induced headache: review and case studies. Monosodium glutamate (MSG), an established headache trigger, has become far more prevalent in canned, packaged and prepared foods over the past decade. The presence of MSG in food may be difficult to detect since the terms "natural flavor," "flavoring," or "hydrolyzed vegetable protein (HVP)," all may appear on food labels to refer to MSG, according to current FDA food labeling codes. HVP typically contains 10-30% MSG. Case studies are presented in which the elimination of all food sources of MSG resulted in decreased headache frequency. Information and food lists helpful in identifying dietary MSG and HVP are presented. When patients are put on an MSG-free trial diet, attention needs to be given to identification of the wide variety of foods containing MSG and HVP.
Identification of false positive exercise tests with use of electrocardiographic criteria: a possible role for atrial repolarization waves Atrial repolarization waves are opposite in direction to P waves, may have a magnitude of 100 to 200 mu V and may extend into the ST segment and T wave. It was postulated that exaggerated atrial repolarization waves during exercise could produce ST segment depression mimicking myocardial ischemia. The P waves, PR segments and ST segments were studied in leads II, III, aVF and V4 to V6 in 69 patients whose exercise electrocardiogram (ECG) suggested ischemia (100 mu V horizontal or 150 mu V upsloping ST depression 80 ms after the J point). All had a normal ECG at rest. The exercise test in 25 patients (52% male, mean age 53 years) was deemed false positive because of normal coronary arteriograms and left ventricular function (5 patients) or normal stress single photon emission computed tomographic thallium or gated blood pool scans (16 patients), or both (4 patients). Forty-four patients with a similar age and gender distribution, anginal chest pain and at least one coronary stenosis greater than or equal to 80% served as a true positive control group. The false positive group was characterized by 1) markedly downsloping PR segments at peak exercise, 2) longer exercise time and more rapid peak exercise heart rate than those of the true positive group, and 3) absence of exercise-induced chest pain. The false positive group also displayed significantly greater absolute P wave amplitudes at peak exercise and greater augmentation of P wave amplitude by exercise in all six ECG leads than were observed in the true positive group.
An innovative method for neuraxis radiotherapy using partial transmission block technique. Whole CNS (neuraxis) radiotherapy is an important part of therapy for certain CNS tumours which seed via the CSF. Many, if not the majority, of these predominantly young patients are cured but the neuropsychometric, neuroendocrine and growth morbidity of neuraxis radiotherapy on children by conventional methods may be considerable; patients receiving such therapy at an early age often are eventually in the educationally subnormal category. Recent radiobiological data support the concept that all aspects of CNS radiation tolerance are heavily dependent on daily fraction size. We describe a new radiotherapy technique that allows lower daily fraction sizes to be delivered to the neuraxis without prejudicing the total dose to the neuraxis or primary area and without prolonging the overall treatment time. Published radiobiological data support the concept that all the major morbidities attributed to conventional neuraxis radiotherapy will be reduced by the currently described technique without reducing tumour control rates.
Mechanical obstruction to ventilation from an ovarian cyst during pregnancy. This report documents the danger of the gravid uterus fixing a large ovarian cyst in a position disadvantageous to diaphragmatic excursion and thereby obstructing ventilation. A 34-year-old pregnant patient presented at 18 weeks amenorrhoea with a large ovarian cyst. She gave a history of exertional dyspnoea and orthopnoea. Clinical examination revealed a grossly enlarged abdomen and a respiratory rate of 28 breaths.min-1. Intraoperatively, ventilation was markedly impaired resulting in cyanosis and bradycardia. This was relieved by drainage of the ovarian cyst. A left lateral tilt with manual traction on the tumour may have avoided this problem. Should the above measures be inadequate, immediate drainage of the cyst is essential. Severe respiratory distress may require ultrasound-guided, percutaneous, aspiration of the cyst preoperatively. However, as in this patient, the absence of gross signs of respiratory failure does not preclude acute ventilatory failure after induction of anaesthesia.
A report of familial carotid body tumors and multiple extra-adrenal pheochromocytomas. A case of familial carotid body tumors and multiple extra-adrenal pheochromocytomas is reported. The carotid body tumors, resected previously, were bilateral and associated with 4 intra-abdominal extra-adrenal pheochromocytomas. Magnetic resonance imaging was far superior to computerized tomography and 131iodine-metaiodobenzylguanidine in visualizing the intra-abdominal lesions, and may soon become the imaging technique of choice in the evaluation of patients with suspected pheochromocytoma.
Prevention of alloimmunization in patients with acute leukemia by use of white cell-reduced blood components--a randomized trial. Platelet refractoriness arising from HLA alloimmunization is a serious complication of transfusion therapy. In a prospective randomized trial, white cell (WBC)-reduced blood components were compared to standard platelet and red cell concentrates with respect to alloimmunization, refractoriness, and platelet increments after transfusion. Sixteen of 31 adult acute leukemia patients received only WBC-reduced platelet concentrates (PCs) and red cells (RBCs), with fewer than 10(6) WBCs per unit. Fifteen control patients received standard blood components with a mean of 0.1 x 10(9) (PCs) and 1 x 10(9) (RBCs) WBCs per unit. Platelet loss during cotton-wool filtration averaged 14 percent (range, 3-32%) from fresh PCs and 24 percent (range, 9-62%) from stored PCs. Filtration did not change corrected increments (CI) measured after transfusion of fresh PCs. The Cl 1 hour after filtration of stored PCs diminished by 27 percent, but the difference was smaller after 18 hours, which suggests better survival of WBC-reduced platelets. The number of platelet units transfused did not differ in the two groups. No patient in the WBC-reduced group developed permanent platelet refractoriness; transient HLA antibodies of low titer developed in two patients. In the control group, one patient became refractory because of immunization and two developed transient HLA antibodies. It can be concluded that the reduction of WBCs in blood components can effectively prevent alloimmunization.
Basophil-bound and serum immunoglobulin E directed against Helicobacter pylori in patients with chronic gastritis. The immunoglobulin (Ig) E immune response in patients with Helicobacter pylori-associated chronic gastritis has been evaluated. Of 26 patients with H. pylori infection, 22 (84%) tested positive for basophil-bound specific IgE (determined by the histamine release test) and 18 (69%) for serum specific IgE (determined by an enzyme-linked immunosorbent assay). In contrast, only 1 of 17 persons in whom the bacterium was not detected presented cell-bound and serum specific IgE. In the 4 histamine release test--positive but enzyme-linked immunosorbent assay--negative patients, removal of antibody from the basophil surface by acid elution showed that histamine release occurred through an IgE-dependent mechanism. When normal basophils, passively sensitized with serum from IgE-positive patients, were exposed to the H. pylori antigen, a significant release was observed, confirming the class specificity of the response. Inhibition experiments with bacteria other than H. pylori showed that the IgE antibody was specifically directed against this organism. The percentage of antigen-induced histamine release did not correlate with serum specific IgE level. However, the response of basophils to antigenic challenge was proportional to IgE-dependent cellular releasability. This finding suggests that target cell sensitivity may be the most important factor in determining the entity of biological response to the antigenic challenge. The ability of H. pylori to induce a specific IgE immune response could answer key questions regarding the mechanisms inducing gastric inflammation.
Personality traits in the mechanisms of interferential therapy for osteoarthritic knee pain. The role of hypochondriacal, depressive, and hysterical personality traits in response to interferential therapy (IFT) was studied in 50 patients with chronic knee osteoarthrosis. Personality traits were assessed through the Minnesota Multiphasic Personality Inventory. Each patient received ten sessions of IFT during two weeks. Pain relief was assessed subjectively (with a numerical pain-relief scale) at the end of treatment and one week later in a single-blind method. Patients who experienced pain relief of 50% or more were considered responders (n = 22). Those who experienced pain relief of 25% or less were considered nonresponders (n = 24). No statistically significant difference was found between the two groups on any of the personality traits studied. These personality traits apparently have no effect on the response of osteoarthritic knee pain to IFT.
Human gallbladder morphology after gallstone dissolution with methyl tert-butyl ether. The effects of methyl tert-butyl ether exposure on the human gallbladder in five patients who were treated for gallstones by contact dissolution is described. Two patients underwent cholecystectomy within 1 week of methyl tert-butyl ether treatment, one patient 2 weeks after, another 10 weeks after, and one 12 weeks after. Indications for cholecystectomy were bilirubinate stones (resistant to methyl tert-butyl ether), catheter dislodgement, bile leakage, and gallstone recurrence (2 patients). Gallstones were dissolved completely in three patients, there was approximately 50% stone reduction in one patient, and no dissolution occurred in the fifth patient. Each gallbladder was examined grossly and histologically. Electron microscopic evaluation was performed in one cases. Typical inflammatory findings of chronic cholecystitis were observed in each gallbladder and were most conspicuous in the submucosa; the mucosal and serosal surfaces were intact. Mild acute inflammatory changes were noted in the submucosa in the two patients with the shortest interval between methyl tert-butyl ether administration and cholecystectomy. There were no ulcerations in the mucosa and no unusual wall thickening or fibrosis in any patient. These observations support the safety of methyl tert-butyl ether perfusion in the human gallbladder; the mild acute changes may be a transient and reversible phenomenon.
Aggressive malignant hemangiopericytoma in the neck. Hemangiopericytomas are rare vascular tumors, one fourth of which occur in the head and neck. These lesions are characteristically slow growing and slow to metastasize. We describe an otherwise healthy patient with a hemangiopericytoma on the left side of his neck that metastasized to his chest wall within 3 months after the tumor was first observed. The metastasis occurred while the patient was receiving radiation therapy. The patient died soon afterward. This case illustrates the aggressive malignant potential of hemangiopericytomas.
Immunization response varies with intensity of acute lymphoblastic leukemia therapy. Twenty-four children receiving maintenance chemotherapy for acute lymphoblastic leukemia were given booster doses of tetanus-diphtheria combined toxoids. One month later, 19 of the 24 children were given Haemophilus influenzae B oligosaccharide-cross-reacting material conjugate vaccine. Following immunization, all patients had protective antibody titers against tetanus, 92% had protective antidiphtheria titers, and 84% had protective titers against H influenzae. Preimmunization titers, postimmunization titers, and response to immunization varied according to the intensity of therapy. There was no correlation with duration of therapy or quantitative hematologic values in the peripheral blood. These observations support the recommendation that children treated for acute lymphoblastic leukemia should be immunized against H influenzae B.
Anomalous insertion of papillary muscle directly into anterior mitral leaflet in hypertrophic cardiomyopathy. Significance in producing left ventricular outflow obstruction. BACKGROUND. Obstruction to left ventricular outflow in hypertrophic cardiomyopathy (HCM) is usually due to systolic anterior motion of the mitral valve. Occurrence of structural mitral valve abnormalities in HCM and their significance in producing outflow obstruction (even in the absence of typical systolic anterior motion) has not been fully appreciated. METHODS AND RESULTS. Analysis of 78 mitral valves excised from patients with obstructive HCM showed that 10 (13%) had anomalous insertion of one or both left ventricular papillary muscles directly into the anterior mitral leaflet. This malformation was identified by echocardiography, which demonstrated direct continuity between the hypertrophied papillary muscle and mitral leaflet, resulting in a long rigid area of midcavity narrowing that appeared to be solely or largely responsible for outflow obstruction. Basal subaortic pressure gradients were large (70-150 mm Hg). Mitral valve replacement reduced the outflow gradient substantially to 0-15 mm Hg in four patients with postoperative cardiac catheterization. However, two other patients who underwent septal myotomy/myectomy had persistent symptoms and incomplete relief of obstruction (gradients 60 and 70 mm Hg) because of continued midcavity apposition of papillary muscle and ventricular septum. CONCLUSIONS. Anomalous papillary muscle insertion into anterior mitral leaflet represents a mechanism of obstruction to left ventricular outflow in patients with HCM and differs considerably from typical dynamic obstruction caused by mitral valve systolic anterior motion that occurs in many other patients with HCM. Recognition of this malformation emphasizes the diverse morphological expression of HCM and also has important clinical implications for patients requiring operation because the gradient is likely to persist even after adequate myotomy/myectomy; consequently, mitral valve replacement would appear to be the operation of choice in most such patients.
Focal nodular hyperplasia of the liver: assessment with contrast-enhanced TurboFLASH MR imaging. Twenty-two patients with 25 cases of focal nodular hyperplasia (FNH) proved with pathologic study were imaged with a TurboFLASH (fast low angle shot) sequence combined with bolus administration of gadolinium tetraazacyclododecanetetraacetic acid (DOTA), spin-echo (SE) T2-weighted sequences, and postcontrast T1-weighted sequences. FNH-liver signal-difference-to-noise ratios were quantified; the features of the central scar were qualitatively analyzed. On SE T2-weighted images, all FNHs were hyperintense; in two cases the central scar exhibited a high signal intensity associated with hypointense areas corresponding to fibrous tissue within the branches of the scar. Unenhanced TurboFLASH images always demonstrated the FNHs as hypointense and always depicted the central scar as a hypointense area within the lesion. After bolus injection, arterial enhancement of FNH was clearly seen, and in 10 of 25 lesions, enhancement within the scar was seen 40-80 seconds after injection. Both unenhanced and enhanced TurboFLASH sequences produced the best signal-difference-to-noise ratios in comparison with T2-weighted images.
Adverse psychologic consequences of positive cytologic cervical screening. Cervical cancer is still widely prevalent in the female population. This study explores the relationship of cervical cancer screening, positive versus negative Papanicolaou's test results, and psychologic status among lower-income minority women. All patients were interviewed 3 months after they had received initial test results. One hundred six women with normal Papanicolaou's test results were compared with 118 women who were referred for colposcopic examination for follow-up of positive test results. Women with positive Papanicolaou's-test results showed statistically significant elevations in worries about cancer and impairments in mood, daily activities, sexual interest, and sleep patterns. More fine-grained analyses revealed that the effects of positive results were most pronounced among those women who did not comply with colposcopy (n = 53). These findings suggest that lack of compliance with follow-up may maintain high levels of uncertainty about disease and may interfere with successful psychologic adaptation. Health education targeted to psychologically vulnerable individuals may reduce psychologic distress and enhance compliance.
Hypothyroidism resulting from generic levothyroxine failure. In today's cost-conscious health care system, generic preparations should be prescribed whenever possible provided that safety and efficacy are not compromised. Several reports, however, suggest that generic levothyroxine may not always be interchangeable with the proprietary preparations. Such interchangeability is critical because patients are likely to receive different brands of levothyroxine during the life of their treatment. We report a case of severe hypothyroidism that developed in a patient who had been well controlled before receiving a generic levothyroxine preparation. Analysis of the patient's tablet by high-pressure liquid chromatography showed that the levothyroxine content was approximately 30 percent less than its labeled content and outside current Food and Drug Administration (FDA) requirements. It is likely that poor tablet bioavailability was a contributory factor. Euthyroidism was achieved with the same dose of a more potent and possibly more bioavailable brand-name product. Until levothyroxine products become more uniform and the FDA confers therapeutic equivalence, product substitution with expense as the principal consideration should be avoided.
Risk factors for pancreatic cellular injury after cardiopulmonary bypass BACKGROUND. Pancreatitis is a known complication of cardiac surgery with cardiopulmonary bypass. Although ischemia is believed to be a factor, the cause of pancreatitis after cardiopulmonary bypass remains unknown. METHODS. We prospectively studied 300 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass. Serum amylase, pancreatic isoamylase, and serum lipase were measured on postoperative days 1,2,3,7, and 10. Pancreatic cellular injury was defined as the presence of hyperamylasemia (greater than 123 U per liter) with an increase in either the serum level of lipase (greater than 24 U per liter) or the peak level of pancreatic isoamylase. Trypsinogen-activation peptides, which indicate intrapancreatic enzyme activation, were measured in the urine of the last 101 patients studied. RESULTS. Evidence of pancreatic cellular injury was detected in 80 patients (27 percent), of whom 23 had associated abdominal signs or symptoms and 3 had severe pancreatitis (2 with pancreatic abscess and 1 with necrotizing hemorrhagic pancreatitis). Two of 19 postoperative deaths were secondary to pancreatitis. In multivariate analyses, the development of pancreatic cellular injury was significantly associated with preoperative renal insufficiency, valve surgery, postoperative hypotension, and perioperative administration of calcium chloride. The administration of more than 800 mg of calcium chloride per square meter of body-surface area was an independent predictor of pancreatic cellular injury, and the increase in risk was dose-related. No differences were found in the level of trypsinogen-activation peptides between patients who had pancreatic cellular injury and those who did not. CONCLUSIONS. Pancreatic cellular injury, as indicated by hyperamylasemia of pancreatic origin, is common after cardiac surgery. The administration of large doses of calcium chloride is an independent predictor of pancreatic cellular injury and may be a cause of it.
The golden hours of the myocardial infarction: nonthrombolytic interventions. Emergency care of patients with acute myocardial infarction requires active decision making to use agents that may improve morbidity and mortality. Thrombolysis remains the primary tool to accomplish this goal. Other pharmacologic agents, including lidocaine, nitrates, calcium channel blockers, beta-blockers, and aspirin, have been used acutely in myocardial infarction in the hopes of preventing death and salvaging myocardium. The decision to select one or all of these agents requires a knowledge of the clinical evidence of their efficacy and risk-to-benefit ratios. The clinical studies of the use of these agents acutely in the management of myocardial infarction are reviewed.
Lower limb problems in diabetic patients. What are the causes? What are the remedies? Peripheral neuropathy, infection, and peripheral vascular disease can produce serious problems in diabetic patients, particularly in the lower limbs. Ulceration of the foot may progress to gangrene and ultimately necessitate amputation. Distal symmetric polyneuropathy causes sensory loss. Such loss in patients with peripheral vascular disease creates a high risk for foot ulcers, which are vulnerable to infection. Treatment includes relief of neuropathic pain and antibiotic therapy for infection. Pentoxifylline (Trental) improves microvascular flow and appears to be effective against peripheral vascular disease. Aldose reductase inhibitors are being investigated as therapy for diabetic neuropathy. Prevention is the mainstay of management in these patients. Patient education is essential to help maintain health and prevent the potential adverse effects of diabetes.
Assessment of 21-[18F]fluoro-16 alpha-ethyl-19-norprogesterone as a positron-emitting radiopharmaceutical for the detection of progestin receptors in human breast carcinomas. We have used 21-[18F]fluoro-16 alpha-ethyl-19-norprogesterone (FENP) for imaging progestin receptors by PET in patients with primary carcinoma of the breast. In vitro binding and in vivo tissue distribution studies in rats have shown that FENP has high specific activity, high affinity for progestin receptors, and receptor-mediated uptake in target tissues. Eight patients with primary breast carcinoma were studied. Breast carcinoma was identified correctly in 50% of the patients with progestin-receptor-positive tumors; however, the FENP uptake was not correlated with progestin-receptor levels. We noted a low target-to-background ratio in humans, with high relative activity in the spine, blood pool, and normal breast tissue. Our findings indicate that FENP is not a suitable agent for imaging progestin receptors in humans.
A case report of malignant pleural mesothelioma with long-term disease control after chemotherapy. Long duration of responses to chemotherapy in patients with malignant pleural mesothelioma (MPM) is rare. The authors report a patient with inoperable MPM who achieved complete remission with combination chemotherapy of cyclophosphamide, doxorubicin, and cisplatin. 5-fluorouracil and mitomycin C (FM) induced another remission after recurrence of the tumor. Retreatment with FM after chemotherapy had been stopped for 20 months yielded another continuing response. The overall tumor-control time is more than 4 years. Literature reviews and the authors' results suggest that MPM may be a chemosensitive tumor in some patients. Additional evaluations of CAP, FM, and methotrexate combination regimens in this disease should be considered.