tbuckley/cabot-search huggingface dataset:
A young woman with recurrent perianal sepsis
Authors: Tom L Kaye, Anthony O'Connor, Dermot Burke, Damian J M Tolan
Journal: BMJ (2015)

A 23 year old woman had been experiencing cramping abdominal pain, alternating diarrhoea and constipation, and episodic blood per rectum for four months. An earlier colonoscopy showed proctitis, which was thought to be indicative of underlying inflammatory bowel disease, and she was started on oral and topical mesalazine. In the following months she was admitted twice with acute perianal sepsis, which required examinations under anaesthesia and drainage of an intersphincteric abscess. She later presented after feeling generally unwell for four days with “flu-like” symptoms and perianal pain. On examination she had tenderness and fluctuance in the region of the right ischial tuberosity, with an external fistula opening visibly in the perineum. Her blood tests show mild neutrophilia (9.40×109/L, reference range 2-7.5) and mildly raised C reactive protein (380.96 nmol/L (40 mg/L), 0-95.24 (0-10) only.



### 1. What imaging modality should be used to investigate this clinical presentation?

#### Answer

Magnetic resonance imaging (MRI) of the pelvis.

#### Discussion

Although a variety of techniques can be used to image perianal fistulas, MRI is widely accepted as the technique of choice for patients who present with recurrent perianal sepsis or signs of complex fistulation and for those with underlying Crohn’s disease. 

Perianal fistulography, in which the external opening of the fistula is catheterised and a water soluble contrast agent injected, is now rarely used. This is because both the primary tract and extensions may fail to fill with contrast and the sphincter muscles are not directly visualised, which hinders anatomical assessment. The test is less accurate and reliable than modern techniques.1 2 

Computed tomography may depict perianal fistulas and associated abscesses …
Book: High Life: A History of High Altitude Physiology and Medicine
Authors: D. R Murdoch
Journal: BMJ (1999)

Oxford University Press, £59.50, pp 510 ISBN 0 19 512194 5 Rating: ![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img> "Now,after the hours of torment … I have nothing more to do than breathe, a great peace floods my whole being. I breathe like someone who has run the race of his life and knows that he may now rest for ever …. In my state of spiritual abstraction, I no longer belong to myself and to my eyesight. I am nothing more than a single, narrow, gasping lung, floating over the mists and the summits." Reinhold Messner's description of the first ascent of … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif
The protection of cells from nitric oxide-mediated apoptotic death by mechanochemically synthesized fullerene (C60) nanoparticles
Authors: Maja S. Misirkic, Biljana M. Todorovic-Markovic, Ljubica M. Vucicevic, Kristina D. Janjetovic, Vukoman R. Jokanovic, Miroslav D. Dramicanin, Zoran M. Markovic, Vladimir S. Trajkovic
Journal: Biomaterials (2009)
Cooperation of Senescence with Self-Renewal in PA1 Embryonal Carcinoma Cells Treated with Etoposide
Authors: J. Erenpreisa, T.R. Jackson, A. Huna, K. Salmina, I. Innashkina, E. Jankevics, P.A. Townsend, M.S. Cragg
Journal: Annals of Oncology (2013)
Prospective Study of Hemostatic Factors and Incidence of Coronary Heart Disease
Authors: Aaron R. Folsom, Kenneth K. Wu, Wayne D. Rosamond, A. Richey Sharrett, Lloyd E. Chambless
Journal: Circulation (1997)

Although hemostatic factors contribute to acute coronary syndromes and atherogenesis, few studies have prospectively evaluated the association between multiple hemostatic factors and coronary heart disease incidence.The Atherosclerosis Risk in Communities Study recruited 14,477 adults from 45 to 64 years of age who were initially free of coronary heart disease. Coronary disease risk factors and several plasma hemostatic factors were measured, and incidence of coronary heart disease was ascertained during an average follow-up of 5.2 years. Age-, race-, and field center-adjusted relative risks of coronary heart disease were significantly elevated (P < or = .05) per higher value of fibrinogen (relative risk: men, 1.76; women, 1.54), white blood cell count (men, 1.68; women, 2.23), factor VIII coagulant activity (women, 1.25), and von Willebrand factor antigen (men, 1.20; women, 1.18). Adjustment for other risk factors attenuated these associations for fibrinogen (adjusted relative risk: men, 1.48; women, 1.21), and it eliminated the white blood cell count, factor VIII, and von Willebrand factor associations, consistent with the other risk factors either confounding or partly operating through their effects on the hemostatic variables. Adjusted standardized relative risks of total mortality, ranging from 1.13 to 1.37, were also elevated (P < .05) in relation to these four factors. There was no association of coronary disease incidence with factor VII, protein C, antithrombin III, or platelet count.Elevated levels of fibrinogen, white blood cell count, factor VIII, and von Willebrand factor are risk factors and may play causative roles in coronary heart disease. However, their measurement in healthy adults appears to add little to prediction of coronary events beyond that of more established risk factors.
No Difference in Cardiac Innervation of Diabetic Patients With Painful and Asymptomatic Coronary Artery Disease
Authors: M Juhani Koistinen, K E Juhani Airaksinen, Heikki V Huikuri, Markku M K Linnaluoto, Juhani Heikkila, Pentti Torniainen, Aapo Ahonen
Journal: Diabetes Care (1996)

OBJECTIVE To test the hypothesis that diabetic autonomic neuropathy interfering with sensory impulses from the heart by sympathetic denervation is the major cause of the high prevalence of asymptomatic coronary artery disease (CAD) in diabetic patients. RESEARCH DESIGN AND METHODS We evaluated cardiac sympathetic innervation in a population-based group of 10 asymptomatic diabetic patients with angiographically proven CAD and in an age- and sex-matched group of 10 diabetic patients with symptomatic CAD using [123I]metaiodobenzylguanide (MIBG) scintigraphy. Exercise electrocardiography and myocardial perfusion imaging by 201Tl were used to detect myocardial ischemia, and standard cardiovascular tests were used to diagnose autonomic nervous dysfunction. RESULTS Thallium scintigraphy revealed perfusion defects in all 10 symptomatic patients and in 9 of the asymptomatic patients. MIBG accumulation defects were found in all cases with painless and with painful disease. In the asymptomatic group, the denervation area exceeded the ischemic area in six cases and areas with total MIBG accumulation defects were seen in four cases. In one case, the MIBG defect was not in the ischemic region. In the symptomatic group, the denervation area exceeded the area of the ischemic region in all cases and areas of total denervation were seen in six cases. The autonomic nervous function tests were abnormal in two asymptomatic and three symptomatic patients with CAD. CONCLUSIONS Cardiac sympathetic denervation is common in both patients with painful CAD and patients with asymptomatic CAD regardless of diabetic autonomic neuropathy. This finding supports the view that sympathetic innervation of the heart is highly sensitive to ischemia and this profound effect of ischemia masks the potential effects of autonomic neuropathy on sympathetic innervation. Mechanisms leading to the lack of ischemic pain in diabetic patients with CAD are complex and are not solely explained by autonomic neuropathy.
Biochemical and clinical evidence that aspirin-intolerant asthmatic subjects tolerate the cyclooxygenase 2-selective analgetic drug celecoxib
Authors: Pär Gyllfors, Grazyna Bochenek, John Overholt, Diane Drupka, Maria Kumlin, James Sheller, Ewa Nizankowska, Peter C. Isakson, Filip Mejza, James B. Lefkowith, Sven-Erik Dahlén, Andrew Szczeklik, John J. Murray, Barbro Dahlén
Journal: Journal of Allergy and Clinical Immunology (2003)
Fetal Growth Restriction Results in Remodeled and Less Efficient Hearts in Children
Authors: Fàtima Crispi, Bart Bijnens, Francesc Figueras, Joaquim Bartrons, Elisenda Eixarch, Ferdinand Le Noble, Asif Ahmed, Eduard Gratacós
Journal: Circulation (2010)

Fetal growth restriction (FGR) affects 5% to 10% of newborns and is associated with increased cardiovascular mortality in adulthood. The most commonly accepted hypothesis is that fetal metabolic programming leads secondarily to diseases associated with cardiovascular disease, such as obesity, diabetes mellitus, and hypertension. Our main objective was to evaluate the alternative hypothesis that FGR induces primary cardiac changes that persist into childhood.Within a cohort of fetuses with growth restriction identified in fetal life and followed up into childhood, we randomly selected 80 subjects with FGR and compared them with 120 normally grown fetuses, matched for gender, birth date, and gestational age at birth. Cardiovascular assessment was performed in childhood (mean age of 5 years). Compared with control subjects, children with FGR had a different cardiac shape, with increased transversal diameters and more globular cardiac ventricles. Although left ejection fraction was similar among the study groups, stroke volume was reduced significantly, which was compensated for by an increased heart rate to maintain output in severe FGR. This was associated with subclinical longitudinal systolic dysfunction (decreased myocardial peak velocities) and diastolic changes (increased E/E' ratio and E deceleration time). Children with FGR also had higher blood pressure and increased intima-media thickness. For all parameters evaluated, there was a linear increase with the severity of growth restriction.These findings suggest that FGR induces primary cardiac and vascular changes that could explain the increased predisposition to cardiovascular disease in adult life. If these results are confirmed, the impact of strategies with beneficial effects on cardiac remodeling should be explored in children with FGR.
Living through the NHS's famine years
Authors: A. Street
Journal: BMJ (2014)

Quality reversals and increasing deficits are symptomatic of deeper problems

The NHS is now well into its predicted famine years,1 and the strain is beginning to tell. Although quality is generally higher than it was 10 years ago, both the King’s Fund’s latest quarterly monitoring report and the latest quality watch report from the Health Foundation and Nuffield Health highlight several reversals in the past few years.2 3 Waiting times for hospital admission have lengthened, with more than 3.1 million people on the waiting list as of August 2014.2 Accident and emergency targets are increasingly missed—the last quarter’s figures showed that 5% of patients spent more than four hours in the emergency department—the highest seasonal level for a decade.2 Inpatient mental health services are becoming harder to access and the improving access to psychological services programme is a long way from serving all those deemed to require such services.3 Tighter eligibility requirements have led to substantial rationing of community based social care.4 Despite progress, England still lags behind other countries in terms of child health and cancer outcomes. Stress among staff has increased, and …
Expectancy in Double-Blind Placebo-Controlled Trials: An Example from Alcohol Dependence
Authors: Ben Colagiuri, Kirsten Morley, Robert Boakes, Paul Haber
Journal: Psychotherapy and Psychosomatics (2009)

&lt;i&gt;Background:&lt;/i&gt; Double-blind placebo-controlled trials are intended to control for the impact of expectancy on outcomes. Whether they always achieve this is, however, questionable. &lt;i&gt;Methods:&lt;/i&gt; Reanalysis of a clinical trial of naltrexone and acamprosate for alcohol dependence investigated this issue further. In this trial, 169 alcohol-dependent patients received naltrexone, acamprosate or placebo for 12 weeks. In addition to being assessed on various indices of alcohol dependence, they were asked whether they believed they received active medication or placebo. &lt;i&gt;Results:&lt;/i&gt; While there were no differences in outcomes between treatment groups, those who believed they had been taking active medication consumed fewer alcoholic drinks and reported less alcohol dependence and cravings. That is, irrespective of actual treatment, perceived medication allocation predicted health outcomes. &lt;i&gt;Conclusions:&lt;/i&gt; These results highlight the differences between treatment administration in clinical trials and standard medical practice, a discrepancy that may sometimes decrease the validity of these types of trials.
Familial multiple discoid fibromas: unique histological features and therapeutic response to topical rapamycin
Authors: J.S. Wee, H. Chong, J. Natkunarajah, P.S. Mortimer, Y. Moosa
Journal: British Journal of Dermatology (2013)

Familial multiple discoid fibromas is a rare genodermatosis that bears some resemblance to Birt–Hogg–Dubé syndrome but is not associated with mutations in the folliculin (FLCN) gene or systemic manifestations. It is characterized by the development of papules over the face and pinnae early in life. Histological findings are of fibrovascular tumours adjacent to hair follicles without features characteristic of fibrofolliculomas, which have recently been termed discoid fibromas. We present siblings with multiple papules over the face and pinnae that developed in childhood. Histological specimens from both siblings demonstrated discoid fibromas, but with some lesions exhibiting an unusual keloidal-like pattern with thick hyalinized collagen fibres surrounded by plump spindle and histiocyte-like cells. FLCN gene mutations were not found. We report on clinical improvement with topical rapamycin solution (1 mg mL−1) applied daily to the face for 4 months. Therapeutic response to topical rapamycin may provide a clue to the underlying genetic basis of this condition.
NHS needs to fast track integrated care to survive credit contraction
Authors: D. Cohen
Journal: BMJ (2009)

The NHS needs to develop integrated care faster to provide better, more cost effective care, a health policy think tank has said.

A report from the Nuffield Trust, called Across the Pond: Lessons from the US on Integrated Care is based on case studies of four integrated care systems in the United States in Colorado and the north west (Kaiser Permanente), Pennsylvania (Geisinger), and Minnesota (Health Partners). All the systems are not for profit but have different models and approaches to governance.

Speaking as the report was launched, Jennifer Dixon, director …
Vitamin D Supplementation During First 12 Months of Life—Reply
Authors: Sina Gallo, Celia Rodd, Hope Weiler
Journal: JAMA (2013)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Circulating and gut-resident human Th17 cells express CD161 and promote intestinal inflammation
Authors: Melanie A. Kleinschek, Katia Boniface, Svetlana Sadekova, Jeff Grein, Erin E. Murphy, Scott P. Turner, Lisa Raskin, Bela Desai, William A. Faubion, Rene de Waal Malefyt, Robert H. Pierce, Terrill McClanahan, Robert A. Kastelein
Journal: The Journal of Experimental Medicine (2009)

The C-type lectin-like receptor CD161, which has recently been described to promote T cell expansion, is expressed on a discrete subset of human CD4 T cells. The function of such cells, however, has remained elusive. We now demonstrate that CD161+ CD4 T cells comprise a circulating and gut-resident T helper 17 (Th17) cell population. During Crohn's disease (CD), these CD161+ cells display an activated Th17 phenotype, as indicated by increased expression of interleukin (IL)-17, IL-22, and IL-23 receptor. CD161+ CD4 T cells from CD patients readily produce IL-17 and interferon γ upon stimulation with IL-23, whereas, in healthy subjects, priming by additional inflammatory stimuli such as IL-1β was required to enable IL-23–induced cytokine release. Circulating CD161+ Th17 cells are imprinted for gut homing, as indicated by high levels of CC chemokine receptor 6 and integrin β7 expression. Supporting their colitogenic phenotype, CD161+ Th17 cells were found in increased numbers in the inflammatory infiltrate of CD lesions and induced expression of inflammatory mediators by intestinal cells. Our data identify CD161+ CD4 T cells as a resting Th17 pool that can be activated by IL-23 and mediate destructive tissue inflammation.
Immunologic Mechanisms of Penicillin Allergy
Authors: Bernard B. Levine
Journal: New England Journal of Medicine (1966)

THE immunologic mechanisms of penicillin allergy are of interest to physicians, not only because of their practical value but also because they can serve as a model for the study of the immunologic mechanisms mediating human allergic diseases in general. Untoward reactions to drugs are not all allergic in mechanism, and the same clinical manifestation can have different fundamental causes. As examples, syncope after injection of penicillin may result from a vasovagal fear reaction or from true anaphylaxis, and hemolytic anemia may be due to a biochemical abnormality of the red blood cell (for example, that induced by primaquine) or . . .
Endotoxin Removal by Magnetic Separation‐Based Blood Purification
Authors: Inge K. Herrmann, Martin Urner, Samuel Graf, Christoph M. Schumacher, Birgit Roth‐Z'graggen, Melanie Hasler, Wendelin J. Stark, Beatrice Beck‐Schimmer
Journal: Advanced Healthcare Materials (2012)

Abstract This work describes a magnetic separation‐based approach using polymyxin B‐functionalized metal alloy nanomagnets for the rapid elimination of endotoxins from human blood in vitro and functional assays to evaluate the biological relevance of the blood purification process. Playing a central role in gram‐negative sepsis, bacteria‐derived endotoxins are attractive therapeutic targets. However, both direct endotoxin detection in and removal from protein‐rich fluids remains challenging. We present the synthesis and functionalization of ultra‐magnetic cobalt/iron alloy nanoparticles and a magnetic separation‐based approach using polymyxin B‐functionalized nanomagnets to remove endotoxin from human blood in vitro . Conventional chromogenic Limulus Amebocyte Lysate assays confirm decreased endotoxin activity in purified compared to untreated samples. Functional assays assessing key steps in host defense against bacteria show an attenuated inflammatory mediator expression from human primary endothelial cells in response to purified blood samples compared to untreated blood and less chemotactic activity. Exposing Escherichia coli ‐positive blood samples to polymyxin B‐functionalized nanomagnets even impairs the ability of gram‐negative bacteria to form colony forming units, thus making magnetic separation based blood purification a promising new approach for future sepsis treatment.
Rectal absorption of short chain fatty acids in the absence of chloride.
Authors: N I McNeil, J H Cummings, W P James
Journal: Gut (1979)

The absorption of short chain fatty acids by the human rectum in the absence of chloride has been studied using a dialysis bag technique. Absorption rates of sodium, water, and short chain fatty acids were unchanged on replacing chloride with sulphate. Final concentrations of bicarbonate were 35.4 +/- 3.4 mmol/l in the presence of chloride and 37.1 +/- 5.2 mmol/l in the absence of chloride. The rates of movement of bicarbonate into the dialysates were similar. If bicarbonate is secreted in exchange for chloride then it also appears to be secreted in exchange for absorbed short chain fatty acids.
Criterion based audit.
Authors: C D Shaw
Journal: BMJ (1990)

Observations in Britain and overseas suggest that the introduction of medical audit seems to have fallen into four phases.In the first (philosophical) phase the debate is whether doctors should be involved, in the second (organisational) phase who should lead and what resources are required, and in the third (practical) phase what should be audited and exactly how; in the fourth (invasive) phase ideas on audit are disseminated through publications and education.This account focuses on the practical phase and the search for a simple method of audit that is applicable generally to medical and surgical specialties.It may therefore be useful first to define the principal characteristics that differentiate formal medical audit from traditional methods of clinical review (box).
The Lung: Radiologic-Pathologic Correlations
Authors: Marvin L. Daves
Journal: JAMA (1974)

An introductory chapter is followed by one on specimen preparation that is valuable for those who wish to use the technique. The third chapter synthesizes the pulmonary anatomy essential to radiologists. This author, like many others, emphasizes that Kerley A, B, and C lines are all thickened interlobular septa. He then proceeds to use the Kerley designations throughout the text, which I found confusing. Conspicuously absent is the anatomic explanation of two expressions used repeatedly, how does the<i>lung field</i>differ from the<i>lung</i>, or the<i>diaphragms</i>from the<i>diaphragm</i>(as applied to a single chest x-ray film)? The fourth chapter correlates roentgenologic patterns with gross and histologic pathology. In ascribing to Gould and Dalrymple the current fad of dividing all disseminated pulmonary disease into alveolar and interstitial, the author ignores the fact that their classification was as follows: bronchoalveolar, vascular, and interstitial, with emphasis on the route of dissemination.
Osteopontin expression in acute renal allograft rejection
Authors: Bassam Alchi, Shinichi Nishi, Daisuke Kondo, Yoshikatsu Kaneko, Asako Matsuki, Naofumi Imai, Mitsuhiro Ueno, Seitaro Iguchi, Minoru Sakatsume, Ichiei Narita, Tadashi Yamamoto, Fumitake Gejyo
Journal: Kidney International (2005)
Every doctor has a duty to report suspected child abuse or neglect, says GMC
Authors: C. Dyer
Journal: BMJ (2012)

All doctors have a duty to report concerns that a child may be at risk of abuse or neglect, even if their work is with adult patients, says new guidance from the General Medical Council.1

Niall Dickson, the GMC’s chief executive, said that doctors need not worry that the regulator would “come after them” as long as they followed the guidance and took action through the proper channels.

Paediatricians have shunned child protection work after high profile cases in which some have been hauled up before the regulator after complaints by parents. Two paediatricians with an international reputation, Roy Meadow and David Southall, were ordered to be struck off the medical register but eventually had the …
Characterization of primitive hematopoietic cells from patients with dyskeratosis congenita
Authors: Frederick D. Goldman, Geraldine Aubert, Al J. Klingelhutz, Mark Hills, Sarah R. Cooper, Wendy S. Hamilton, Annette J. Schlueter, Karen Lambie, Connie J. Eaves, Peter M. Lansdorp
Journal: Blood (2008)