shukoor65/lab-rag-model huggingface dataset:
Rearrangement of the T-cell receptor delta chain gene in T-cell lymphomas with a mature phenotype. The configuration of the T-cell receptor (TCR) delta chain gene was assessed using restriction fragment analysis and the Southern blot technique in 39 T-cell lymphomas with a mature immunophenotype. The TCR delta gene was rearranged in four lymphomas although the gamma/delta TCR was not expressed in two cases studied. The TCR delta gene was the only TCR gene rearranged in two cases. Each lymphoma with TCR delta gene rearrangement had an aberrant T-cell immunophenotype and three cases were of the large cell anaplastic type. The TCR delta gene was deleted in 22 cases and was in the germline configuration in 13 lymphomas. Deletion of the TCR delta gene was characteristic of mycosis fungoides, adult T-cell leukemia/lymphoma (human T cell leukemia-lymphoma virus positive), and Lennert's lymphoma, and was not identified in angiocentric lymphomas. In eight cases with TCR delta deletion, however, a large number of polyclonal (presumably reactive) T cells were present and, in these lymphomas, the authors could not determine if TCR delta gene deletion occurred in the polyclonal T cells, the neoplastic cells, or both cell populations. The authors conclude that the TCR delta gene is usually deleted in mature T-cell lymphomas, as would be expected in alpha/beta TCR T cells. However, TCR delta gene rearrangement is detectable in approximately 10% of cases. Analysis of this locus may be useful diagnostically, as it occasionally may be the only molecular marker of clonality in mature T-cell lymphomas T-cell receptor delta chain gene rearrangement also is found most often in lymphomas of the large cell anaplastic type.
Disposition of high-dose methotrexate in an obese cancer patient. The disposition of many drugs in obesity is altered, although little is known of the effect of obesity on the pharmacokinetics of anti-cancer drugs. In this report the authors describe the pharmacokinetics of high-dose methotrexate in an obese woman (184% ideal body weight) with osteosarcoma. For this patient, both the volume of distribution at steady-state (0.398 l/kg) and systemic clearance (0.0956 l/h/kg) of methotrexate were increased compared with values observed in adult patients with osteosarcoma. The terminal elimination half-life (9.29 hours) of methotrexate was similar to other reported values in adult patients, thus indicating that increases in methotrexate volume of distribution and clearance may offset each other in obesity. Based on the experience gained from this patient, the authors suggest that renal function and methotrexate serum concentrations should be monitored in obese patients receiving high-dose methotrexate with leucovorin rescue.
The clinical utility of maternal body mass index in pregnancy. To describe maternal body mass index and to compare the use of maternal weight and body mass index for risk assessment at the initial prenatal visit, 6270 gravid women who were consecutively delivered of infants were studied. Body mass index increased with advancing maternal age, parity, and advancing gestational age and was significantly greater in black women than in nonblack women. Risks for the development of adverse outcome associated with maternal obesity, including development of gestational diabetes, preeclampsia, fetal macrosomia, and shoulder dystocia, were comparably predicted by either maternal weight or body mass index greater than 90th percentile. Maternal weight was as predictive of preeclampsia, macrosomia, and shoulder dystocia as was body mass index when these factors were analyzed as continuous variables, whereas increasing body mass index was more predictive of gestational diabetes. The prediction of factors associated with low maternal weights, small-for-gestational-age birth, prematurity, low birth weight, and perinatal death was equivalent for maternal weight and body mass index that was less than 10th percentile. This study indicates that in the initial risk assessment of outcomes related to maternal weight, the calculation of maternal body mass index offers no advantage over simply weighing the patient. This finding contrasts with results in nonpregnant women.
Aging, autonomic function, and the perception of angina. OBJECTIVE--To determine the effects of age and autonomic function on the perception of angina. DESIGN--Prospective evaluation of the relations between anginal perceptual threshold, autonomic function, and systolic blood pressure in patients with symptomatic coronary artery disease. Statistical analysis was by non-parametric techniques. SETTING--Cardiology departments of a district general hospital and a post-graduate teaching centre. SUBJECTS--82 non-diabetic men with typical exertional angina and coronary artery disease confirmed by arteriography (n = 64) or a history of Q wave infarction (n = 18). MAIN OUTCOME MEASURES--Age, anginal perceptual threshold, autonomic function, and blood pressure. Anginal perceptual threshold was defined as the time from onset of 0.1 mV ST depression to the onset of angina during treadmill stress testing. Autonomic function was measured as the ratio of peak heart rate during the Valsalva manoeuvre to the minimum rate after release. RESULTS--Anginal perceptual threshold showed a weak but significant correlation with age, with older patients tending to have a longer interval between the onset of ST depression and the onset of angina. Comparison of patients in the upper and lower quartile age ranges showed a difference of 50 seconds between median threshold measurements. Blood pressure and heart rate responses to the Valsalva manoeuvre also correlated with age, but neither variable correlated with the anginal perceptual threshold. CONCLUSIONS--In non-diabetic men with coronary artery disease the perception of angina tends to deteriorate with advancing age. The mechanism is unclear but is not attributable solely to alterations in blood pressure or autonomic function.
Colitis due to Histoplasma capsulatum in the acquired immune deficiency syndrome. We present a case of colonic histoplasmosis in a young HIV antibody-positive homosexual male who presented with acute diarrhea. The diagnosis was made by flexible sigmoidoscopy with biopsy which revealed organisms morphologically consistent with Histoplasma capsulatum, and was later confirmed by fungal culture of the biopsy specimens. At colonoscopy, skip areas with plaques, ulcers, and a pseudopolyp were observed. The colitis resolved endoscopically after a 6-wk course of intravenous amphotericin B, and the patient has had no recurrence of symptoms while on maintenance therapy with amphotericin B. However, the organisms continue to be noted on biopsies of normal-appearing areas in the rectum and sigmoid 5 months after diagnosis. Colonic involvement with H. capsulatum, an organism endemic to the Midwest, may be seen more frequently as the total number of cases of HIV-infected individuals increases in this region.
A critical look at scheduled relaparotomy for secondary bacterial peritonitis. Scheduled relaparotomy is attracting interest as a means of treating intra-abdominal sepsis. It is the subject of several studies to evaluate its role in the management of peritoneal infection. However, indications for this procedure are not clear and current knowledge does not allow for adequate scientific evaluation. Many trials lack control groups and historical control groups cannot be evaluated on criteria, such as illness severity, concomitant health problems or even surgical technique. Indicators of outcome are generally described in insufficient detail; only death or survival are reported and important morbidity and resource utilization data are not included. A randomized, prospective, multicenter clinical trial using standardized techniques is necessary to determine the usefulness of scheduled relaparotomy performed on different patients.
Acute pulpal-alveolar cellulitis syndrome. V. Apical closure of immature teeth by infection control: the importance of an endodontic seal with therapeutic factors. Part 2. During orthodontic treatment to promote eruption of maxillary and mandibular second bicuspids, a young male patient had a severe endodontic cellulitis of a mandibular bicuspid. Apexogenesis and resolution of the periapical lesion was achieved by infection control with nonspecific intracanal medication without calcium hydroxide, as stated by Das. A mild periodontal cellulitis occurred shortly thereafter and rapidly resolved. A second endodontic cellulitis, after apexogenesis without an endodontic seal, occurred shortly after completion of orthodontic treatment. This also quickly resolved, and the canal was effectively sealed. This case indicates the importance of an effective endodontic seal shortly after apexogenesis is induced by infection control. This report and others on the subject indicate that apexogenesis of nonvital permanent immature teeth by infection control is a predictable endodontic treatment procedure.
Characterization of refractory period extension by transcardiac shock. BACKGROUND. To better understand the refractory period extension (RPE) produced by transcardiac shocks and its possible role in defibrillation, we measured RPE under various experimental conditions. METHODS AND RESULTS. Using ventricular pacing in pentobarbital-anesthetized dogs, we characterized RPE in relation to the anatomic site of pacing, the local voltage gradient (LVG) produced by the shocks at the pacing site, and the pacing rate and pacing current used to make the measurements. We also determined if RPE persisted into the next refractory period after the shock and measured RPE at the end of 30-second episodes of acute ischemia to the pacing site, which were caused by occluding the left anterior descending artery. Each anatomic site tested showed RPE, which increased sharply with increasing LVG at lower levels but less sharply at higher LVG. The RPE versus LVG was approximated with an exponential curve that had an exponential constant of about 5-6 V/cm. At faster pacing rates, RPE occurred earlier in the refractory period but was unchanged when expressed as a percent increase of refractory period. RPE did not vary with the pacing current and was present only in the refractory period during which the shock was delivered. The RPE was not significantly altered by acute ischemia. These results show that transcardiac shocks selectively extend the refractory period of tissue proportional to the LVG and the timing of the shock in the refractory period. They are consistent with the concept that RPE prevents depolarization from tissue directly excited by a shock from propagating to tissue that was refractory to that same shock. CONCLUSIONS. The insensitivity of RPE to short ischemic episodes and the presence of RPE at increased activation rates suggest that RPE might exist under conditions of fibrillation and be a major determinant of the success or failure of defibrillation.
A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. We examined the relationship of maturity-onset clinical diabetes mellitus with the subsequent incidence of coronary heart disease, stroke, total cardiovascular mortality, and all-cause mortality in a cohort of 116,177 US women who were 30 to 55 years of age and free of known coronary heart disease, stroke, and cancer in 1976. During 8 years of follow-up (889 255 person-years), we identified 338 nonfatal myocardial infarctions, 111 coronary deaths, 259 strokes, 238 cardiovascular deaths, and 1349 deaths from all causes. Diabetes was associated with a markedly increased risk of nonfatal myocardial infarction and fatal coronary heart disease (age-adjusted relative risk [RR] = 6.7; 95% confidence interval [CI], 5.3 to 8.4), ischemic stroke (RR = 5.4; 95% CI, 3.3 to 9.0), total cardiovascular mortality (RR = 6.3; 95% CI, 4.6 to 8.6), and all-cause mortality (RR = 3.0; 95% CI, 2.5 to 3.7). A major independent effect of diabetes persisted in multivariate analyses after simultaneous control for other known coronary risk factors (for these end points, RR [95% CI] = 3.1 [2.3 to 4.2], 3.0 [1.6 to 5.7], 3.0 [1.9 to 4.8], and 1.9 [1.4 to 2.4], respectively). The absolute excess coronary risk due to diabetes was greater in the presence of other risk factors, including cigarette smoking, hypertension, and obesity. These prospective data indicate that maturity-onset clinical diabetes is a strong determinant of coronary heart disease, ischemic stroke, and cardiovascular mortality among middle-aged women. The adverse effect of diabetes is amplified in the presence of other cardiovascular risk factors, many of which are modifiable.
Acute effects of pulsatile levodopa administration on central dopamine pharmacodynamics. Inconsistencies in the response to individual levodopa doses occur in most patients with advanced Parkinson's disease (PD). To investigate the possible development of acute tachyphylaxis, we evaluated the effects of repeated injections of intravenous levodopa in 10 PD patients with motor fluctuations by administering, during a single day, a previously determined optimal levodopa dose repeatedly each time motor function returned to baseline. Peak antiparkinsonian response was lower by 20%, and peak plasma levodopa levels lower by 35% following the first dose compared with all subsequent doses. Neither peak dyskinesia scores nor the duration of motor response changed significantly with successive levodopa doses. These data suggest that pulsatile levodopa administration does not acutely alter dopamine receptor responsiveness, and that other pharmacokinetic and pharmacodynamic factors contribute to the dose-to-dose variability in response to levodopa.
Kinetics of D-xylose absorption in patients with human immunodeficiency virus enteropathy. D-Xylose absorption was studied in 12 patients with acquired immunodeficiency syndrome (AIDS) or advanced AIDS-related complex who had had diarrhea for more than 8 weeks, averaged an 11% (range, 3% to 21%) body weight loss during the previous 6 months, and had had negative stool examinations for enteric pathogens. Patients were evaluated by duodenal aspiration and biopsy and received both 25 gm oral and 10 gm intravenous doses of D-xylose. Kinetic analysis of D-xylose absorption was characterized by an absorption rate constant (ka) and a rate constant (ko) reflecting nonabsorptive loss. Extent of D-xylose absorption averaged 18.4% +/- 9.3% (+/- SD) in the 12 patients (normal greater than 60%). Percentage of weight loss during the previous 6 months was negatively correlated with ka (r = -0.69; p = 0.018) in the 11 patients in whom this parameter was reduced but was not correlated with either ko or extent of D-xylose absorption. In these patients with human immunodeficiency virus enteropathy, ka was reduced out of proportion to the minor histologic changes present in the duodenal biopsy specimens.
Strawberry hemangioma of infancy: early definitive treatment with an argon laser. This report documents the successful treatment of a hemangioma (strawberry hemangioma) at 5 weeks of age with the argon laser. The natural course of strawberry hemangioma of infancy is well known. It begins as a very small spot and develops very rapidly within the first few weeks of life. Many grow to a very large size and produce significant morbidity. It is logical to assume that if these were ablated early, the life cycle could be aborted. The patient of this case study developed two spots that appeared to be typical evolving hemangiomas. One was treated and disappeared. The other was not treated and evolved into a typical strawberry hemangioma that eventually involuted. This would indicate that early treatment holds some promise.
Cytomegalovirus ileitis presenting as massive rectal bleeding in infancy. Two Zambian infants presented with massive rectal bleeding caused by cytomegalovirus ileitis. The first was seropositive for HIV and the second seronegative, though her mother was seropositive. Both infants died.
Electrocardiographic findings in a patient with pure septal infarction. The electrocardiogram in a 65 year old man in whom pure septal infarction had been produced by occlusion of the septal branch during percutaneous transluminal coronary angioplasty showed that this had led to the disappearance of septal Q waves and reciprocal ST segment depression in the inferior leads.
Acute, subacute, and chronic myocardial infarction: quantitative analysis of gadolinium-enhanced MR images. The value of gadolinium enhancement to enable detection of infarcted myocardium at T1-weighted magnetic resonance (MR) imaging was assessed in 84 patients after acute myocardial infarction (AMI). Five healthy subjects served as controls. All patients underwent MR imaging before and 20 minutes after administration of gadopentetate dimeglumine. Contrast enhancement of normal myocardium varied 7% +/- 4 after administration of gadopentetate dimeglumine. Mean intensity ratio after gadolinium enhancement in group 1 (imaging less than 1 week after AMI), group 2 (imaging 1-3 weeks after AMI), and group 3 (imaging 3-6 weeks after AMI) was significantly higher than before gadolinium enhancement. In group 4 (imaging more than 6 weeks after AMI), no significant difference was observed. After gadolinium enhancement, the intensity ratio was abnormally increased in 82% of the MR examinations in group 1, in 62% of group 2, in 58% of group 3, and in 12% of group 4. Gadolinium enhancement improved visualization of myocardial infarction at MR imaging up to 6 weeks after onset of symptoms and had a maximal effect within 1 week after AMI.
Relationship between the onset of dysmenorrhea and histologic findings in adenomyosis. An attempt was made to evaluate the relationship between histologic findings of adenomyosis and onset of dysmenorrhea. Thirty-four cases of histologically diagnosed adenomyosis were investigated in this study. One large sample cut along the longitudinal axis was made and examined to evaluate the histologic parameters and CA 125 levels. Dysmenorrhea was classified into grade I (absent or mild) and grade II (severe). Localization of adenomyosis was divided into type I, adenomyosis continuous from the surface endometrium (29 cases), and type II, adenomyosis present on the serous side of the uterus and not continuous from the surface endometrium (five cases). We made type I adenomyosis, which included 13 cases of grade I and 16 cases of grade II, the focus of our investigation. The parameters that correlated with dysmenorrhea were the number of islands of adenomyosis and glands, distance of invasion, relative rate of invasion, and CA 125 levels. The differences between grades I and II were apparent in the frequency distribution tables, with dysmenorrhea occurring at invasion rates of 80% and greater.
Immunohistochemical detection of renal carbonic anhydrase of patients with recurrent urolithiasis. In renal exploratory excisions the isoenzyme C of the carbonic anhydrase was detected in 51 operative treated patients with recurrent urolithiasis and in 6 patients with ren mobilis or stenosis of the ureteral pelvic junction by using the immunohistochemical PAP-method. In the distal tubules and collecting ducts there is an alternating occurrence of cells with small and those with strong reactivity. This correlates with the distribution of mean or principal (P-, small reaction) and intercalated (I-, strong reaction) cells. The number of carbonic anhydrase rich cells and the degree of their cytoplasmic reaction to this enzyme seem to correlate with the ability of the urine to acidify. The patients were divided into four groups according to the mean urine pH estimated for a period of two weeks. The third group with predominantly acid urine (pH less than 5.8) showed a significantly increased number of carbonic anhydrase rich cells (mean = 63% +/- 6, n = 18) as compared to the first group (controls) without urolithiasis and normal urine (pH 5.8-6.8, mean = 46% +/- 8, n = 6) or the second group with urolithiasis and normal urine (pH 5.8-6.8, mean = 46% +/- 8, n = 28). The fourth group with predominant alkaline urine (pH greater than 6.8) showed a significantly decreased number of intercalated cells (mean = 42% +/- 16, n = 5) in comparison to the third group. Indeed, the difference with the control group is not significant but the cytoplasmic reaction of I-cells decreases distinctly in comparison to all other groups.
Acute traumatic midbrain hemorrhage: experimental and clinical observations with CT. Traumatic brain stem hemorrhage (TBH) after blunt head impact is an uncommon injury and has historically been associated with high mortality. Retrospective clinical review identified 64 patients with TBH admitted during a 5-year period. Complete imaging and clinical records for 45 of these patients demonstrated that TBH could be categorized into three groups. The most frequent site of hemorrhage, in 31 (69%) of 45 patients (group 1), was the midline rostral anterior brain stem, posterior to the interpeduncular cistern, and this injury was associated with a 71% survival rate. This pattern was also associated with a predominantly anterior site of head and/or face impact. Eight (18%) patients (group 2) had miscellaneous foci of acute brain stem hemorrhage with seven (88%) surviving. Six (13%) patients (group 3) had brain stem hemorrhage associated with transtentorial herniation and brain stem compression, with 100% mortality. Experimental findings in a canine model and clinical results indicate that the anterior rostral midbrain is a common site of TBH and appears to arise from sudden craniocaudal displacement of the brain at impact. Survival is unexpected high with this location of traumatic midbrain hemorrhage.
Intrinsic vasculature of the labyrinthine segment of the facial nerve--implications for site of lesion in Bell's palsy. Recent studies of the intrinsic vasculature of the cat facial nerve have demonstrated relatively poor blood supply to the labyrinthine segment. In this study, the intrinsic vasculature of the human facial nerve was systematically evaluated in 25 temporal bones and three fresh cadaver nerves. Cross-sectional vessel counts were obtained for the labyrinthine, tympanic, and mastoid segments. Capillary densities for each segment were derived from these data. The labyrinthine segment of the human facial nerve, like that in the cat, contains fewer and smaller intrinsic blood vessels than do the mastoid and tympanic segments. This may indicate that the labyrinthine segment of the facial nerve may be more vulnerable to ischemic damage. In conjunction with the previously demonstrated narrowness of the labyrinthine fallopian canal, these findings support the contention that the labyrinthine segment is a likely site of lesion in Bell's palsy.