bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pupillary evaluation for differential diagnosis of coma
Authors: Tokuda Y , Nakazato N , Stein G H 
Published: February 2003

Abstract

Objectives
To determine the usefulness of bedside evaluation of pupils in determining the aetiology of coma by adopting a probabilistic approach.

Patients and methods
One hundred and fifteen consecutive patients presenting with coma were enrolled in this prospective cohort during the 12 month study period in the emergency room of a community teaching hospital. Patients underwent structured clinical examinations and laboratory and imaging tests. Assignment of aetiology of coma was based on strict adherence to predetermined criteria and achieved by consensus of the two physician investigators. One year follow up was obtained in all patients.

Results
Aetiology of coma was determined in 98% of the patients. It was metabolic in 69 patients (60%) and structural in 46 patients (40%). Metabolic causes included drug overdose, acute alcohol intoxication, hypoglycaemia, sepsis, and pneumonia. Structural causes included intracerebral haemorrhage, subarachnoid haemorrhage, cerebral infarction, subdural haematoma, and epidural haematoma. Multivariate logistic regression analysis showed light reflex loss (likelihood ratio for positive test result 3.59) and anisocoria (likelihood ratio for positive test result 9.0) as independent predictors of structural origin.

Conclusions
In this prospective study of patients presenting to the emergency room of a community based teaching hospital with coma, in about 60% the coma is of metabolic origins and in about 40% of structural origins. Light reflex loss and anisocoria suggest a structural aetiology.
Drotrecogin alfa (activated): a novel therapeutic strategy for severe sepsis
Authors: Pastores S M 
Published: February 2003

Abstract
Recent studies have highlighted the close link between activation of the coagulation system and the inflammatory response in the pathophysiology of severe sepsis. The protein C anticoagulant pathway plays an integral part in modulating the coagulation and inflammatory responses to infection. In patients with sepsis, endogenous protein C levels are decreased, shifting the balance toward greater systemic inflammation, coagulation, and cell death. On the basis of a single large randomised phase 3 trial, drotrecogin alfa (activated), a recombinant form of human activated protein C, was recently approved for the treatment of adult patients with severe sepsis and a high risk of death. Since its approval, several questions have been raised regarding the appropriate use of this agent. Given the increased risk of serious bleeding and the high cost of treatment, drotrecogin alfa (activated) should be reserved at this time for the most acutely ill patients with severe sepsis who meet the criteria that were used in the phase 3 trial.
Are medical reports on fitness to drive trustworthy?
Authors: Steier T S , Kitai E , Wiener A , Kahan E 
Published: February 2003

Abstract

Purpose
Previous studies have shown that physicians often have poor knowledge of the medical restriction on fitness to drive, or submit poor quality medical reports. To determine the reliability of physicians’ reports on fitness to drive, the medical data provided on the standard medical fitness form was compared with the additional data collected on repeated assessment.

Methods
A random sample of 100 applicants for a driver’s licence aged more than 49 years who submitted the standard medical form were asked to provide, from their regular family doctor, confirmation of their health status and/or additional medical data in order to make a re-evaluation.

Results
The rate of rejection for a licence for medical reasons was 3% on the basis of the standard evaluation and 17% on the basis of the re-evaluation (p&lt;0.001).

Conclusion
This study shows that the random evaluation of physician assessments of applicants for a driver’s licence increases the detection rate of medical problems that can affect fitness to drive. The alarming difference in the rate of rejection between the two assessments may reflect a lackadaisical attitude of medical professionals toward the licence assessment procedure and/or physician unawareness of the medical restrictions on fitness to drive. Results of this study suggest that this subject must be included in medical education programmes.
Unusual complications of thyroid carcinoma
Authors: Owen P J D , Lazarus J H , Morse R E 
Published: February 2003

Abstract
Thyroid carcinomas are the most frequent endocrine malignancies. Complications may arise from an established malignancy and these may lead to the initial clinical presentation or cause subsequent problems. In this case report two elderly patients with differentiated and undifferentiated thyroid carcinomas who suffered unusual medical complications are described. The incidence and treatment of thyroid carcinoma is discussed and the importance of fine needle aspiration of thyroid nodules and the recognition of iodine containing radiographic contrast media in the causation of iodine induced thyrotoxicosis is highlighted.
Late small bowel obstruction after blunt abdominal trauma
Authors: Maharaj D , Perry A , Ramdass M , Naraynsingh V 
Published: February 2003

Abstract
Blunt abdominal trauma with intraperitoneal injury usually presents acutely. On rare occasions, such patients can present later on with features of small bowel obstruction due to stricture formation. It is thought that such a delayed stricture is due to subclinical bowel perforation, localised gut ischaemia, or injury to the mesenteric vasculature. This case demonstrates the mesenteric vascular injury theory to be the cause of the bowel stricture.
Phantom lymphadenopathy. An association with chronic fatigue syndrome
Authors: Shee C D 
Published: February 2003

AbstractTen patients with self diagnosed enlarged lymph glands were referred to a general medicine outpatient clinic and careful examination did not confirm lymphadenopathy. All patients also complained of severe chronic fatigue associated with aches and miscellaneous somatic symptoms, and fulfilled criteria for diagnosis of chronic fatigue syndrome (CFS). Phantom lymphadenopathy may be a symptom in some people with CFS, and possible reasons for this are discussed.
Cardiac Hypertrophy: The Good, the Bad, and the Ugly
Authors: Frey N. , Olson E.N. 
Published: January 2003

▪ Abstract  Cardiac hypertrophy is the heart's response to a variety of extrinsic and intrinsic stimuli that impose increased biomechanical stress. While hypertrophy can eventually normalize wall tension, it is associated with an unfavorable outcome and threatens affected patients with sudden death or progression to overt heart failure. Accumulating evidence from studies in human patients and animal models suggests that in most instances hypertrophy is not a compensatory response to the change in mechanical load, but rather is a maladaptive process. Accordingly, modulation of myocardial growth without adversely affecting contractile function is increasingly recognized as a potentially auspicious approach in the prevention and treatment of heart failure. In this review, we summarize recent insights into hypertrophic signaling and consider several novel antihypertrophic strategies.The same thing that makes you live can kill you in the end.     —Neil Young
TAXUS III Trial
Authors: Tanabe Kengo , Serruys Patrick W. , Grube Eberhard , Smits Pieter C. , Selbach Guido , van der Giessen Willem J. , Staberock Manfred , de Feyter Pim , Müller Ralf , Regar Evelyn , Degertekin Muzaffer , Ligthart Jurgen M.R. , Disco Clemens , Backx Bianca , Russell Mary E. 
Published: February 2003

Background—The first clinical study of paclitaxel-eluting stent for de novo lesions showed promising results. We performed the TAXUS III trial to evaluate the feasibility and safety of paclitaxel-eluting stent for the treatment of in-stent restenosis (ISR).Methods and Results—The TAXUS III trial was a single-arm, 2-center study that enrolled 28 patients with ISR meeting the criteria of lesion length ≤30 mm, 50% to 99% diameter stenosis, and vessel diameter 3.0 to 3.5 mm. They were treated with one or more TAXUS NIRx paclitaxel-eluting stents. Twenty-five patients completed the angiographic follow-up at 6 months, and 17 of these underwent intravascular ultrasound (IVUS) examination. No subacute stent thrombosis occurred up to 12 months, but there was one late chronic total occlusion, and additional 3 patients showed angiographic restenosis. The mean late loss was 0.54 mm, with neointimal hyperplasia volume of 20.3 mm3. The major adverse cardiac event rate was 29% (8 patients; 1 non-Q-wave myocardial infarction, 1 coronary artery bypass grafting, and 6 target lesion revascularization [TLR]). Of the patients with TLR, 1 had restenosis in a bare stent implanted for edge dissection and 2 had restenosis in a gap between 2 paclitaxel-eluting stents. Two patients without angiographic restenosis underwent TLR as a result of the IVUS assessment at follow-up (1 incomplete apposition and 1 insufficient expansion of the stent).Conclusions—Paclitaxel-eluting stent implantation is considered safe and potentially efficacious in the treatment of ISR. IVUS guidance to ensure good stent deployment with complete coverage of target lesion may reduce reintervention.
LE POUVOIR MORAL ET SPIRITUEL DES FEMMES DANS LE VODOU HAÏTIEN: LA VOIX DE MAMA LOLA ET DE KAREN MCCARTHY BROWN
Authors: Michel Claudine 
Published: February 2003

AbstractThe article attempts to interpret morality in Haitian Vodou by illustrating its ethical framework in the day-to-day realities of its followers. In so doing, I demonstrate how Vodou as a living system of belief and practice has historically served as the informal infrastructure for morality in Haiti. To this end, I draw upon the work of Karen McCarthy Brown whose work on Mama Lola, a Haitian priestess living in Brooklyn, is an insightful venture into the heart of this widely misunderstood religious and social system. Furthermore, this essay offers the perspective of a very distinctive single voice which emerges from the long and complex dialogue between the multiple voices of the researcher/observer/participant and the manyfaceted voices of the priestess/informant. Their diverse perspectives and individual utterances fuse successfully in a powerful articulation of feminist intervention and cultural understanding. Their lives and their work clearly establish how the Haitian religion empowers women and how the manbo subtly manifests Haitian female power.
THE SATANIC RITUAL ABUSE PANIC AS RELIGIOUS-STUDIES DATA
Authors: Frankfurter David 
Published: February 2003

AbstractRumors and alleged memories of Satanic cult activity swept through the U.S. and U.K. during the 1980s and 1990s, confounding scholars of religion, as well as jurists and psychologists, with their combination of tantalizing ritual scenes and dubious forensic evidence. This essay discusses the work done on these Satanic cult claims since the early 1990s in a variety of academic fields; and it critiques some of the scholarly responses from the field of Religious Studies in particular.
INDIVIDUAL VARIATION IN THE ACOUSTIC BEHAVIOUR OF THE ADULT MALE LEOPARD SEAL, HYDRURGA LEPTONYX
Authors: Rogers Tracey , Cato Douglas 
Published: February 2003

AbstractVocalisations and vocalising bouts of adult male leopard seals recorded from the Prydz Bay region, East Antarctica, were compared to determine whether they showed individual variability. There were distinct individual patterns in the sequence of vocalisations within vocalising bouts. A sequence could be reliably ascribed to a particular individual with a high degree (83%) of certainty. Such sequences may carry information about the identity of the caller. Acoustic characteristics of the two most commonly used vocalisations, the high and low double trills, showed weak within individual variation. Although differences were observed among individuals in the high double trill few were observed in the low double trill consequently the low double trills of some individuals could not be reliably ascribed to any particular seal. For many species, individual variation occurs in acoustic characteristics of specific vocalisations rather than in the sequence in which the vocalisations are produced. The acoustic displays of solitary species such as the leopard seal, are constrained by the difficulties of detecting and recognising the signal at a distance. Vocalisation sequences may be less adversely affected by signal degradation and so could be effective for communicating information over distance. It has been suggested that individual acoustic variation is found primarily in gregarious species however findings from the current study suggest that solitary animals using long-range underwater acoustic displays may convey individual variability in their vocalising sequence patterns.
FOUR LETTERS OF SAYH HASAN AL-'ATTĀR TO SAYH TĀHIR AL-HUSAYNĪ OF JERUSALEM
Authors: Abu-Manneh Butrus 
Published: February 2003

AbstractSayh Hasan al-'Attār, a young 'ālim of al-Azhar, left Egypt for the Ottoman-Turkish lands in 1803. He stayed there for seven years before moving to Damascus in 1810 where he stayed for the next three and a half years. In late 1813 he joined the Hağğ caravan to Mecca. On his way back he went to Jerusalem where he enjoyed the hospitality of its hanafī muftī Sayh Tāhir al-Husainī whom he apparently befriended while the latter was studying at al-Azhar. From Jerusalem he returned to Egypt in the spring of 1814. The four letters sent by 'Attār to Sayh Tāhir shed a light on his movements and mood of thought at that time, and on the relations between 'ulamā' of al-Azhar and those of Jerusalem and the cultural interests of the latter. Two of the letters are of special importance because they give us a first hand account of his way back to Cairo and of the personal hardships which he encountered after his resettlement there. Moreover, he referred in them to the books which he started to teach and to the great interest they aroused among the Azharite students. In short those rare letters show a side of 'Attār's life unknown to scholars and help us to understand the condition of the 'ulamā' under Muhammad Alī.
DREAMS, DOCUMENTS AND 'FETISHES': AFRICAN CHRISTIAN INTERPRETATIONS OF THE PILGRIM'S PROGRESS
Authors: Hofmeyr Isabel 
Published: February 2003

AbstractJohn Bunyan's The Pilgrim's Progress, a key text of the evangelical Protestant missionary movement, was translated into eighty African languages and consequently influenced African Christian intellectual traditions. This article examines one aspect of this influence, namely the ways in which Bunyan's portrayal of literacy in The Pilgrim's Progress became a site around which African reworkings of the text cohered. For Bunyan, a first-generation literate, literacy is a source of spiritual authority but also a source of powerlessness as documents are used to persecute the poor. African Christians likewise experienced literacy as a source of power and powerlessness. This contradiction often produced the phenomenon of 'miraculous literacy' in which believers magically gain the ability to read through spiritual gifts rather than via mission or colonially controlled institutions. Documents also gain talismanic or 'fetish-like' properties, a view not far removed from evangelical theories of text that likewise invest documents with extraordinary capacities.
Intranodal injection of semimature monocyte-derived dendritic cells induces T helper type 1 responses to protein neoantigen
Authors: Gilliet Michel , Kleinhans Martin , Lantelme Erica , Schadendorf Dirk , Burg Günter , Nestle Frank O. 
Published: January 2003

AbstractDendritic cells (DCs) represent the most potent antigen-presenting cells of the immune system capable of initiating primary immune responses to neoantigens. Here we characterize the primary CD4 T-cell immune response to protein keyhole limpet hemocyanin (KLH) in 5 metastatic melanoma patients undergoing a tumor peptide–based dendritic cell vaccination trial. Monocyte-derived dendritic cells displaying a semimature phenotype, as defined by surface markers, were loaded ex vivo with antigen and injected intranodally at weekly intervals for 4 weeks. All patients developed a strong and long-lasting delayed-type hypersensitivity reactivity to KLH, which correlated with the induction of KLH-dependent proliferation of CD4 T cells in vitro. Secondary in vitro stimulation with KLH showed significant increase in interferon-γ and interleukin-2 (IL-2) but not IL-4, IL-5, nor IL-10 secretion by bulk T cells. On the single-cell level, most TH1 cells among in vitro–generated KLH-specific T-cell lines confirmed the preferential induction of a KLH-specific type 1 T helper immune response. Furthermore, the induction of KLH-specific antibodies of the IgG2 subtype may reflect the induction of a type 1 cytokine profile in vivo after vaccination. Our results indicate that intranodal vaccination with semimature DCs can prime strong, long-lasting CD4 T-cell responses with a TH1-type cytokine profile in cancer patients. (Blood. 2003;102:36-42)
Genetic evidence for convergence of c-Kit– and α4 integrin–mediated signals on class IA PI-3kinase and the Rac pathway in regulating integrin-directed migration in mast cells
Authors: Tan Bai Lin , Yazicioglu Mustafa N. , Ingram David , McCarthy Jennifer , Borneo Jovencio , Williams David A. , Kapur Reuben 
Published: January 2003

AbstractMast cells play a critical role in host defense against a number of pathogens. Increased mast cell infiltration has been described in allergic asthma, in rheumatoid arthritis, and during helminthes infection. Despite the importance of mast cells in allergic disease and defense against infection, little is known about the mechanisms by which mast cells migrate to various tissues under steady state conditions or during infection or inflammation. Here, we show that activation of c-Kit by its ligand, stem cell factor (SCF), cooperates with α4 integrin in inducing directed migration of mast cells on fibronectin. A reduction in migration and activation of a small G protein, Rac, was observed in mast cells derived from class IA phosphoinositide-3 kinase (PI-3kinase)–deficient mice in response to SCF stimulation and in mast cells expressing the dominant-negative Rac (RacN17), as well as in mast cells deficient in the hematopoietic-specific small G protein, Rac2. In addition, a PI-3kinase inhibitor inhibited α4- as well as SCF-induced migration in a dose-dependent fashion. In contrast, a mitogen-activated protein kinase (MAPK) inhibitor had little effect. Consistent with the pharmacologic results, abrogating the binding of the p85α subunit of class IA PI-3kinase to c-Kit also resulted in inhibition of SCF-induced migration on fibronectin. These genetic and biochemical data demonstrate that both c-Kit and α4 integrin signaling are linked to class IA PI-3kinase and Rac pathways and regulate integrin-directed (haptotactic) migration in mast cells.
A unique atrial primary cardiac lymphoma mimicking myxoma presenting with embolic stroke: a case report
Authors: Quigley Michael M. , Schwartzman Eric , Boswell Pamela D. , Christensen Rebecca L. , Gleason Lisa A. , Sharpe Robert W. , d'Amato Thomas A. 
Published: January 2003

Abstract
An immunocompetent 29-year-old male presented with an embolic stroke from an unusual primary cardiac lymphoma. The cardiac lesion consisted of a polypoid, left atrial, mural fibrin thrombus with anaplastic tumor cells lining the surface of the clot. Histologic, immunophenotypic, and molecular characterizations were consistent with a diagnosis of CD30+ large B-cell lymphoma with anaplastic cytology. While tumor emboli from invasive primary cardiac lymphomas have been reported, this noninvasive fibrin thrombus–associated lymphoma appears to be unique and previously unreported.
Ethnic variations in pathways to and use of specialist mental health services in the UK
Authors: Bhui Kamaldeep , Stansfeld Stephen , Hull Sally , Priebe Stefan , Mole Funke , Feder Gene 
Published: February 2003

BackgroundInequalities of service use across ethnic groups are important to policy makers, service providers and service users.AimsTo identify ethnic variations in pathways to specialist mental health care, continuity of contact, voluntary and compulsory psychiatric in-patient admissions; to assess the methodological strength of the findings.MethodA systematic review of all quantitative studies comparing use of mental health services by more than one ethnic group in the UK. Narrative analysis supplemented by meta-analysis, where appropriate.ResultsMost studies compared Black and White patients, finding higher rates of in-patient admission among Black patients. The pooled odds ratio for compulsory admission, Black patients compared with White patients, was 4.31 (95% CI 3.33–5.58). Black patients had more complex pathways to specialist care, with some evidence of ethnic variations in primary care assessments.ConclusionsThere is strong evidence of variation between ethnic groups for voluntary and compulsory admissions, and some evidence of variation in pathways to specialist care.
Migration as a risk factor for schizophrenia: A Danish population-based cohort study
Authors: Cantor-Graae Elizabeth , Pedersen Carsten Bøcker , Mcneil Thomas F. , Mortensen Preben Bo 
Published: February 2003

BackgroundA growing body of evidence suggests that migration is a risk factor for the development of schizophrenia, although the putative mechanism remains obscure.AimsTo examine immigrant background and history of foreign residence as risk factors for schizophrenia.MethodUsing data from the Danish Civil Registration System, we established a population-based cohort of 2.14 million persons resident in Denmark by their fifteenth birthday. Schizophrenia in cohort members and parental psychiatric disorder were identified by cross-linkage with the Danish Psychiatric Case Register.ResultsThe relative risk of developing schizophrenia was 2.45 (95% CI 2.25–2.67) and 1.92 (95% CI 1.74–2.12) among first- and second-generation immigrants respectively, and 1.60 (95% CI 1.25–2.05) among Danes with a history of foreign residence.ConclusionsMigration confers an increased risk for schizophrenia that is not solely attributable to selection factors and may also be independent of foreign birth.
Predicting engagement with services for psychosis: insight, symptoms and recovery style
Authors: Tait Lynda , Birchwood Max , Trower Peter 
Published: February 2003

BackgroundTreatment non-adherence and service disengagement are commonly attributed to impaired insight. There is evidence that recovery style (i.e. psychological adjustment) may underlie service engagement.AimsWe examined whether insight, psychotic symptoms or individuals' recovery style (‘integration’ v. ‘sealing-over’) predicts service engagement.MethodFifty patients with schizophrenia were assessed during acute psychosis and at 3-month and 6-month follow-ups. Measures included recovery style, psychosis symptoms, insight and service engagement.ResultsSealing-over at 3 months following onset of an episode of psychosis predicted low service engagement at 6 months. Neither insight nor symptoms predicted engagement. The clear shift from integration to sealing-over within the first 3 months was independent of changes in symptoms or insight. Sealing-over between 3 and 6 months was associated with improvement in psychosis symptoms.ConclusionsRecovery style contributed more to engagement than did insight, appears to be dynamic in the short term and is orthogonal to insight. Overall, this study demonstrated the importance of addressing psychological adjustment to psychosis as well as illness status when investigating treatment engagement in people with psychosis.