shukoor65/lab-rag-model huggingface dataset:
Appropriateness of intrapartum fetal heart rate management and risk of cerebral palsy. Cerebral palsy affects 2 in 1000 infants in the United States, and the intrapartum period is frequently scrutinized as the etiologic source. In a matched group of 49 infants with cerebral palsy at 1 year of age and 49 controls, no difference in the incidence of inappropriate intrapartum fetal heart rate pattern management was detected. This supports the conclusions of others that the intrapartum period is an infrequent source of cerebral palsy.
Assessment of aortoiliac obstructive disease by Doppler spectrum analysis of blood flow velocities in the common femoral artery at rest and during reactive hyperemia. Aortoiliac obstructive disease was assessed by Doppler spectrum analysis of blood flow velocities in the common femoral artery measured both at rest and during reactive hyperemia. The intraarterial femoral artery pressure measured at rest and during reactive hyperemia served as the "gold standard" for the definition of a hemodynamically significant aortoiliac stenosis. Our results, obtained from 93 patients (136 limbs), showed that differences between Doppler spectra obtained from limbs with a hemodynamically significant aortoiliac stenosis and those from limbs without were more pronounced during reactive hyperemia than at rest. The best assessment of aortoiliac obstructive disease could be obtained with a combination of parameters derived from Doppler spectra measured at rest and during reactive hyperemia. With these parameters, obtained by multivariate analysis, 85% of the limbs were diagnosed correctly compared with the gold standard. If angiographic data were added to the gold standard, even 91% of the limbs were diagnosed correctly. We conclude that analysis of Doppler spectra-obtained noninvasively from the common femoral artery at rest and during reactive hyperemia provides an accurate hemodynamic assessment of the aortoiliac segment.
Generation of intracellular signals by low density lipoprotein is independent of the classical LDL receptor. Low density lipoprotein cholesterol (LDL) and apolipoprotein B-100 (1 to 15 micrograms/mL) had no significant influence on the inositol-1,4,5-trisphosphate (InsP3) formation in vascular smooth muscle cells and fibroblasts. Low density lipoprotein cholesterol (15 micrograms/mL) induced an elevation of intracellular Ca2+ from 85 to approximately 210 nmol/L in vascular smooth muscle cells from rat aorta in the absence or in the presence of 15 micrograms/mL monoclonal antibodies against the classical low density lipoprotein receptor or in the presence of apolipoprotein B-100. Moreover, in both human cultured fibroblasts from normocholesterolemic individuals and from patients with familial hypercholesterolemia homozygote class 1, LDL induced a dose-dependent rise of free intracellular calcium and a biphasic change of intracellular pH. Since homozygote class 1 fibroblasts are classical LDL receptor negative, and as antibodies against this receptor, as well as apolipoprotein B-100, did not attenuate the LDL-induced elevation of cytosolic calcium, we conclude that LDL might modify vascular activity via the observed intracellular changes without involving the classical low density lipoprotein receptor.
Pharmacodynamic parameters and toxicity of netilmicin (6 milligrams/kilogram/day) given once daily or in three divided doses to cancer patients with urinary tract infection. The pharmacologic parameters and toxicity of netilmicin (6 mg/kg/day) given once daily (qd) or thrice daily (tid) for the treatment of urinary tract infections were studied in a randomized prospective study of 60 cancer patients. The overall efficacy was 96%. Nephrotoxicity, assessed by the measure of urinary excretion of phospholipids, was lower for the patients receiving the qd regimen than for those receiving the tid regimen. Elevation of serum creatinine (20% over baseline) occurred in one patient receiving the qd regimen and in three receiving the tid regimen. Cochleotoxicity, assessed by pure-tone audiometry (250 to 18,000 Hz) occurred in one patient receiving the qd regimen and none receiving the tid regimen. Concentrations in sera were measured on days 1 and 5. No significant accumulation was observed in either group. Median serum bactericidal titers, expressed as reciprocal values (percentage of the sera with a titer greater than or equal to 8), were measured against 25 test organisms in samples collected 6 h after the administration of netilmicin and were, for the qd group, 16 (82%) against members of the family Enterobacteriaceae and less than 2 (8%) against Pseudomonas aeruginosa, and for the tid group, 4 (57%) against members of the Enterobacteriaceae and less than 2 (0%) against P. aeruginosa. The rate of killing in serum was rapid (2 to 3 log in 2 h against P. aeruginosa; 3 to 5 log in 2 h against members of the Enterobacteriaceae) and correlated with the sampling time and hence the concentration in serum of netilmicin. The duration of the postantibiotic effect in serum depended also on the strain and the sampling time of the serum.
Transrectal US in the diagnosis of localized colitis cystica profunda. Colitis cystica profunda (CCP) mimicks rectal carcinoma, which makes distinguishing this benign lesion from the more common rectal neoplasm clinically and pathologically difficult. When transrectal ultrasound (US) was used in this case, three features of CCP were seen. There were multiple lesions, which did not penetrate beyond the submucosa. A large cystic component was seen, with a layer of uniform thickness in two of the three lesions. Non-solid contents and a lack of infiltration can be visualized at transrectal US, which helps diagnose CCP.
Intracerebral grafting impedes hippocampal cell loss during withdrawal after long-term alcohol consumption in rats. We previously found that, in the hippocampal formation as well as other central nervous system regions, withdrawal from alcohol following long periods of ingestion did not impede the ethanol-induced degenerative changes, including cell loss: on the contrary, neuronal degeneration was found to be increased in withdrawn rats. By grafting withdrawn rats either with immature hippocampal blocks or with suspensions of cultured astrocytes, we hoped to arrest the process of cell loss or even reverse it, because it is known that grafted material might display trophic and eventually protective effects in conditions of brain damage. The dentate granule and hippocampal CA3 pyramidal cells were counted both in the grafted hemisphere and in the contralateral one. Grafts of astrocyte suspensions did not interfere with the ongoing process of cell death in withdrawn rats. Conversely, grafts of hippocampal tissue impeded the degeneration observed in the granule and pyramidal cells of the grafted hemisphere, although in the contralateral one the cell loss persisted. We therefore conclude that the protective effect displayed by solid grafts might be a local process dependent on the release of diffusible trophic agents. We cannot explain the absence of any effect displayed by astroglial grafts, inasmuch as in different experimental situations such an effect was described.
The evaluation of patients with human immunodeficiency virus-related disorders and brain mass lesions. In patients at risk for acquired immunodeficiency syndrome who present with a mass lesion, a dilemma arises as to whether to treat empirically for toxoplasmosis or perform a brain biopsy. We present data that further define the indications for performing brain biopsy vs empiric treatment. We reviewed charts on 59 patients with acquired immunodeficiency syndrome--related disorders and cerebral mass lesions. Thirty-two patients met diagnostic criteria for toxoplasmosis. Bayesian analysis demonstrated that the prior probability of toxoplasmosis was increased by the presence of contrast enhancement on computed tomographic scans (0.68) and toxoplasmosis titers greater than 1:64 (0.81). Features associated with decreasing probabilities of toxoplasmosis included the absence of contrast enhancement on computed tomographic scans (0.29) and toxoplasmosis titers less than or equal to 1:64 (0.14). Ten percent of patients had complications of brain biopsy. Treatment with pyrimethamine and sulfadiazine produced complications in 29% and serious complications in 8% of treated patients. These data favor empiric therapy for patients with typical features of toxoplasmosis and brain biopsy for defined subsets of patients with atypical features.
Long-term patency of the aortofemoral Dacron graft. A graft limb related study over a 25-years period. Graft limb patency was studied retrospectively in a consecutive series of 912 patients (1605 limbs), who received an aorto(bi)femoral Dacron graft for occlusive disease over a 25 years period (1963-1987). The mean follow-up for the series was 5.35 years (range 1 month to 23 years) and 18.5% of the patients were followed for at least 10 years. Primary patency decreased progressively to 83% at 10 years and 77% at 15 years. It was significantly improved to 90% (at 10 years) and 84% (at 15 years) by means of operative thrombectomy (secondary patency). Factors influencing patency (univariate analysis) were (1) concomitant femoropopliteal occlusive disease, (2) the site of the femoral anastomosis and (3) the date of the operation. Multivariate analysis in relation to the femoral anastomosis stressed the importance of profunda femoris artery disease and the date of operation. It is concluded that the negative effects of concomitant superficial femoral artery disease may be completely relieved by an adequate profundaplasty. Furthermore the substantial progress, we documented over the years of the study, supports our view that aortofemoral reconstruction may also be offered as the solution of choice to patients with milder forms of claudication.
A history of boron neutron capture therapy of brain tumours. Postulation of a brain radiation dose tolerance limit. Boron neutron capture therapy (BNCT) is a form of radiation therapy mediated by the short-range (less than 10 microns) energetic alpha (4He) and lithium-7 (7Li) ionizing particles that result from the prompt disintegration by slow neutrons of the stable (nonradioactive) nucleus boron-10 (10B). Recent advances in radiobiological and toxicological evaluation of tumour-affinitive boron-containing drugs and in optimization of the energies of neutrons in the incident beam have spurred interest in BNCT. This article presents a history of BNCT that emphasizes studies in the USA. A new dosimetric analysis of the 1959-1961 clinical trials of BNCT at Brookhaven National Laboratory is also presented. This analysis yields an acute radiation dose tolerance limit estimate of approximately 10 Gy-Eq to the capillary endothelium of human basal ganglia from BNCT. (Gy-Eq: Gray-equivalent, or relative biological effectiveness of a radiation component multiplied by the physical dose of the component (Gy), summed over the component kinds of radiation.).
Intra-articular fractures of the distal part of the radius treated with the small AO external fixator. Thirty adults who had a severely comminuted intra-articular closed fracture of the distal part of the radius were treated by closed reduction and AO external fixation consisting of a converging-pin configuration with a double row of connecting bars. The patients were followed for an average of 2.6 years (range, two to four years). Twenty-seven patients had an excellent result; two, a good result; and one, a poor result, on the basis of pain, motion, strength, and radiographic appearance. Complications were rare, and there was no loss of fixation of the pins. The average grip strength was 92 per cent of normal. Motion of the wrist and rotation of the forearm averaged more than 90 per cent of that of the normal side. Carpal height was used as an indicator of distraction force produced by the fixator. There was an average increase in carpal height of four millimeters initially and 3.7 millimeters immediately before removal of the fixator, indicating near-constant distraction throughout the treatment. Radial length was well maintained, with shortening averaging less than one millimeter. The converging pins of the AO fixator prevent loosening, thereby diminishing the risks of infection, loss of reduction of the fracture, and breakage of the pins. This geometry of the pins allows the use of smaller-diameter (2.5-millimeter) pins and provides rigid fixation, even in osteoporotic bone.
Spontaneous pneumomediastinum. A report of 25 cases. Spontaneous pneumomediastinum (SPM) is a relatively uncommon, infrequently reported entity. To determine the clinical presentation and sequelae of SPM, data were obtained from 25 patients: 14 from Hadassah University Hospital, and 11 from other medical institutions. The mean age was 18.8 +/- 5.2 years (+/- SD), with a range of 8 to 31 years. The most common presenting complaint was retrosternal pain in 22 patients (88 percent), dyspnea in 15 (60 percent), dysphagia in 10 (40 percent), and weakness in 10 (40 percent). Predisposing factors for the development of SPM could be identified in 18 patients (72 percent). Information on the sequelae of SPM during a mean period of 87.4 +/- 38.0 months following the initial SPM episode was obtained from 23 patients. Recurrent SPM occurred in 1 patient at 18 months, and another patient experienced 4 episodes of recurrent spontaneous pneumothorax. No other long-term sequelae were reported. We conclude that SPM is a benign self-limited disease with diverse clinical manifestations. Although uncommon, recurrences of SPM may be observed.
Traumatic pericallosal aneurysm in a patient with no major trauma. Case report. The case of a young woman who developed a traumatic distal anterior cerebral artery ("pericallosal") aneurysm from a roller-coaster ride is described. She presented with a subarachnoid hemorrhage (SAH) restricted to the interhemispheric fissure. The initial angiogram was normal but repeat angiography at 8 days revealed the aneurysm. After craniotomy and clipping the patient made a satisfactory recovery. This is the only reported case of a traumatic aneurysm arising under circumstances not usually considered as trauma. It raises questions about the pathophysiology of the formation of such aneurysms and suggests that traumatic pericallosal aneurysms should be considered in SAH of unknown etiology. This case provides further evidence that repeat angiography occasionally helps reveal an aneurysm when the initial study fails to do so.
Hypoxic pulmonary vasoconstriction in systemic sclerosis and primary pulmonary hypertension. Reduction of pulmonary vascular resistance by a high inspired oxygen concentration is a common, but not universal phenomenon in patients with pulmonary vascular disease of varying etiology that may determine their response to long-term domiciliary oxygen therapy. We therefore determined changes in PVR during oxygen therapy in two patient populations not previously studied: systemic sclerosis (n = 8, mean age +/- SEM, 44.5 +/- 5.4 years) and primary pulmonary hypertension (n = 7, mean age +/- SEM 38 +/- 7.8 years). All patients were hypoxemic (arterial oxygen tension, on air 9.5 +/- 1.2 kPa for SSc and 8.3 +/- 0.6 kPa for PPH, p greater than 0.05). Right atrial pressure, pulmonary artery pressure, pulmonary artery occlusion pressure, systemic arterial pressure, PaO2 and cardiac output by thermodilution were measured at three, 20-min intervals while inspiring air and again after inspiring 60 percent oxygen for 30 min. The PVR fell significantly with oxygen in patients with SSc from 797.6 +/- 179.2 to 610 +/- 151.6 dynes/s/cm-5 (p less than 0.01), and this fall correlated with baseline PAP and PaO2 prior to oxygen therapy (r = 0.86, p less than 0.025; r = 0.77, p less than 0.05, respectively). In patients with PPH, there was no significant fall in PVR with oxygen (from 969 +/- 80.2 to 851.9 +/- 91.2 dynes/s/cm-5, p greater than 0.05) and no predictor of a vasodilator response in individual patients. In SSc, hypoxic pulmonary vasoconstriction contributes more consistently to elevated PVR than in patients with PPH.
Quantification of cervical change: relationship to preterm delivery in the multifetal gestation. Prematurity is the major contributor to the very high perinatal morbidity and mortality associated with multifetal gestations. Antepartum cervical evaluation has been suggested as a way to better define the risk of preterm delivery in multifetal gestations. Weekly digital cervical examinations were performed in 86 twin and 7 triplet gestations that were being monitored in a special antepartum clinic. A cervical score was calculated from each examination by subtracting cervical dilatation in centimeters from cervical length in centimeters. Cervical scores decline gradually with advancing gestation and are influenced by parity and subsequent preterm delivery. Intervals until delivery decrease significantly with lower cervical scores. A cervical score less than or equal to 0 on or before 34 weeks' gestation was strongly predictive of preterm delivery (75%). Only 2 of 78 (2.6%) with a score greater than 0 were delivered within 1 week of the examination. Cervical scoring is a simple, quantifiable, reproducible, and safe method of evaluating preterm delivery risk. An understanding of the prognostic significance of specific cervical scores may be of value in determining the need for obstetric intervention.
Nitrogen mustard, vincristine, procarbazine, and prednisone as adjuvant chemotherapy in the treatment of medulloblastoma. A Pediatric Oncology Group study. In a randomized postoperative trial, adjuvant post-irradiation chemotherapy, consisting of nitrogen mustard, vincristine, procarbazine, and prednisone (MOPP), was tested versus radiation therapy alone for newly diagnosed medulloblastoma in patients between 1 and 21 years of age. Patients treated with irradiation plus MOPP had a statistically significant increase in overall survival rate at 5 years posttreatment compared to patients treated with radiation therapy alone (74% vs. 56%; p = 0.06, adjusted for race and gender). Although the overall study failed to show a statistically significant advantage for irradiation plus MOPP in event-free survival (p = 0.18), statistical significance was attained in children 5 years of age or older (p = 0.05). More severe hematological toxicities occurred in the group with irradiation plus MOPP; however, this hematotoxicity appeared to be tolerable and acceptable. These results suggest that patients may benefit from combined irradiation and chemotherapy following surgery for medulloblastoma.
Imaging of metastatic colorectal cancer with tumour-activated killer lymphocytes. Adoptive immunotherapy may be useful for treating or visualising metastatic cancer. Lymphocytes were taken from 6 patients with metastatic colorectal cancer and cultured with cells from the patients primary tumour to produce tumour-activated killer (TAK) lymphocytes. We re-injected each patient with IIIIn-labelled TAK cells in order to visualise metastases. Images were taken with a gamma-camera for up to 48 h after injection. Metastases were revealed as early as 4 h in the lung and as late as 48 h in the abdomen. Liver images produced "cold" spots corresponding to metastatic lesions. Lymph nodes were not visualised. Re-injection of TAK cells raised against autologous colorectal tumours reveals the sites of metastases.
Fibroblast cell interactions with human melanoma cells affect tumor cell growth as a function of tumor progression. It is known from a variety of experimental systems that the ability of tumor cells to grow locally and metastasize can be affected by the presence of adjacent normal tissues and cells, particularly mesenchymally derived stromal cells such as fibroblasts. However, the comparative influence of such normal cell-tumor cell interactions on tumor behavior has not been thoroughly investigated from the perspective of different stages of tumor progression. To address this question we assessed the influence of normal dermal fibroblasts on the growth of human melanoma cells obtained from different stages of tumor progression. We found that the in vitro growth of most (4 out of 5) melanoma cell lines derived from early-stage radial growth phase or vertical growth phase metastatically incompetent primary lesions is repressed by coculture with normal dermal fibroblasts, suggesting that negative homeostatic growth controls are still operative on melanoma cells from early stages of disease. On the other hand, 9 out of 11 melanoma cell lines derived from advanced metastatically competent vertical growth phase primary lesions, or from distant metastases, were found to be consistently stimulated to grow in the presence of dermal fibroblasts. Evidence was obtained to show that this discriminatory fibroblastic influence is mediated by soluble inhibitory and stimulatory growth factor(s). Taken together, these results indicate that fibroblast-derived signals can have antithetical growth effects on metastatic versus metastatically incompetent tumor subpopulations. This resultant conversion in responsiveness to host tissue environmental factors may confer upon small numbers of metastatically competent cells a growth advantage, allowing them to escape local growth constraints both in the primary tumor site and at distant ectopic tissue sites.
Borrelia rhombencephalomyelopathy. Three patients, in whom the diagnosis of Borrelia burgdorferi infection was unknown for several years, developed a biphasic involvement of the central nervous system: an acute brain-stem dysfunction was followed up, in two patients, by a progressive, disabling myelitis and, in one patient, by further relapsing-remitting episodes of severe multifocal rhombencephalitis. The most consistent cerebrospinal fluid abnormalities in the analysis of sequential specimens were elevated total IgM levels that normalized after penicillin therapy. The neuropathologic findings in one patient showed microgliosis and meningovascular involvement of the central nervous system, resulting in two ischemic infarcts in the myelencephalon. Few spirochetes were localized in the leptomeninges and around subependymal vessels of the fourth ventricle. The vascular element consisted of an obliterative inflammatory vasculopathy in the medullary parenchyma. This study (1) provides pathologic evidence that a vascular disease induced by B burgdorferi is a pathogenetic mechanism for cerebrovascular diseases, and (2) emphasizes the similarities between neuroborreliosis and neurosyphilis.
Thallium myocardial scintigraphy in congenitally-corrected transposition of the great arteries. A case of congenitally-corrected transposition of the great arteries is presented with the correlation of thallium scintigraphic results with catheterization data. The essential features of the thallium scintigrams were marked counterclockwise rotation of the heart with perfusion abnormalities of the inferior wall and apex. Since patients with congenitally-corrected transposition of the great arteries may present with the symptom of chest pain, the diagnosis of transposition of the great arteries should be considered in patients with marked counterclockwise rotation of the heart and segmental perfusion abnormalities on thallium scintigraphy.
Chemical peritonitis associated with intraperitoneal vancomycin. A case of chemical peritonitis associated with intraperitoneal vancomycin is reported. A 23-year-old woman presented with signs and symptoms consistent with a chronic ambulatory peritoneal dialysis catheter exit-site infection. Intraperitoneal vancomycin (Vancoled) 1 g was given, followed by 25 mg/L into each subsequent exchange. On day 4 the patient developed abdominal pain and cloudy dialysis effluent. The vancomycin was discontinued, and the dialysate cleared by day 8. Fluid cultures were negative, and Staphylococcus aureus was isolated from the exit site. Subsequent intravenous vancomycin, and smaller intraperitoneal doses, failed to repeat the event. Fluid and serum white blood cell count, serum immunoglobulins and complement, culture results, and the temporal relationship are strongly suggestive of a vancomycin-induced chemical peritonitis.