tbuckley/cabot-search huggingface dataset:
PMO-105 Pancreatic pseudocyst management: experience from a DGH centre
Authors: J Kavanagh, R Sringeri, S Shetty
Journal: Gut (2012)

<h3>Introduction</h3> Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Diagnosis is usually accomplished by cross sectional imaging and cyst fluid analysis will help in differentiating pseudocyst from other cystic lesions of pancreas. Most of them resolve with supportive care but intervention is required if there are persistent symptoms or develop any complications.<sup>1</sup> Our aim was to review the practice of pancreatic pseudocyst management in a DGH set up and to formulate a care pathway or protocol supported by good evidence base. <h3>Methods</h3> Retrospective case notes review of patients diagnosed with pancreatic pseudocyst. Patients were identified by ICD classification based clinical coding database. Data collected includes patient demographics, aetiology of pancreatitis, size and number of cysts, diagnostic modalities used, associated symptoms and complications, indication for intervention and type of intervention used and follow-up strategy <h3>Results</h3> 62 patients were diagnosed to have pancreatic pseudocyst in last 7 years. Median age 60 yrs (range 24–91 yrs), male to female ratio was 1.4:1. Total of 81% (n=50) had history of acute pancreatitis. Alcohol (n=32, 50%) was the commonest underlying aetiology. Abdominal pain was the commonest symptom (n=55, 89%) and 10% (n=6) were asymptomatic. CT scan was used as diagnostic modality in 90% (n=56) and USS in 74% (n=46). Total of 82% (n=51) had a single cyst where as 18% (n=11) had multiple. Average cyst size was 70 mm (range 10–270 mm). About 76% (45/59, three died) had follow-up scan and average duration of follow-up was 13 months. Of them, cyst got increased in size in 32% (n=15), decreased in size in 23% (n=11), no change in 28% (n=11) and got resolved in 17% (n=8). Total of 43% (n=23) had their symptoms resolved spontaneously without requiring any intervention. Complications were noted in 28 % (n=17, CBD obstruction-7, cyst infection-6, gastric/duodenal obstruction-3 and cyst rupture in 1). About 39% (n=24) required intervention because of persistent symptoms or due to complications. Persisting pain (n=18, 29%) and increase in cyst size (n=7, 11%) were the commonest indications. In 58% (n=14) endoscopic, 33%(n=8) percutaneous and 8%(2) required surgical drainage. Of those who had intervention, 79% (n=19) required once, 17% (n=4) twice and 4% (n=1) thrice. Overall 79 % (19/24) had symptoms resolved post intervention. <h3>Conclusion</h3> Pancreatic pseudocysts were managed conservatively in more than half of the patients group. In nearly one fifth of patients spontaneous resolution of cysts were noted in follow-up scans. Those who required intervention, endoscopic method was the most common method used and many patients achieved good resolution of their symptoms. <h3>Competing interests</h3> None declared. <h3>References</h3> 1. <b>Andren Sandenberg A,</b><i>et al</i>. <i>JOP</i> 2004;<b>5</b>:8–24.
Effect of ultrasound on tissue-type plasminogen activator-induced thrombolysis.
Authors: C G Lauer, R Burge, D B Tang, B G Bass, E R Gomez, B M Alving
Journal: Circulation (1992)

BACKGROUND The efficacy of fibrinolytic therapy is limited by the small surface area of the clot that is available for the binding of the thrombolytic agent, such as tissue-type plasminogen activator (t-PA). We hypothesized that exposure of the clot to ultrasound during thrombolytic treatment could enhance lysis through perturbation of the thrombus, which would expose additional fibrin binding sites for t-PA. METHODS AND RESULTS Whole human blood clots containing radiolabeled fibrinogen were incubated in vitro for 200 minutes with Tris-albumin buffer containing t-PA at concentrations ranging from 3 to 3,000 IU/ml. In paired experiments, one of the clots also was exposed to intermittent ultrasound (1 MHz, 1.75 W/cm2) throughout the experiment. The ultrasound was delivered as a 2-second exposure followed by a 2-second rest interval. The overall difference in mean clot lysis between thrombi receiving ultrasound and those receiving no ultrasound was significant (p less than 0.001) at all concentrations of t-PA. For clots incubated with t-PA at a concentration of 300 IU/ml, ultrasound increased the percent lysis at 200 minutes from 42 +/- 5% (mean +/- SEM) to 64 +/- 10%. In six paired experiments in a rabbit jugular vein thrombosis model, rabbits received 1 mg t-PA alone or t-PA and intermittent ultrasound (1 MHz, 1.75 W/cm2) for 200 minutes. For rabbits receiving ultrasound and t-PA, lysis was 55 +/- 11% at 100 minutes compared with 30 +/- 12% for rabbits receiving only t-PA. Lysis was 6 +/- 10% for rabbits (n = 4) receiving ultrasound alone. No evidence for tissue damage was noted in rabbits exposed to intermittent ultrasound. CONCLUSIONS Exposure of whole blood clots in vitro to intermittent ultrasound combined with t-PA caused a significant enhancement of thrombolysis compared with t-PA alone. Intermittent ultrasound also showed a trend toward enhancement of t-PA-induced clot lysis in an animal thrombosis model. These data suggest that noninvasive intermittent ultrasound may be a useful adjunct to thrombolytic therapy.
Psychometric Properties of Self-Report Scales of Alexithymia
Authors: Stuart Shipko, Nicholas Noviello
Journal: Psychotherapy and Psychosomatics (1984)

The purpose of this paper is to provide further insight into the quantification and measurement of alexithymia. A series of statistical surveys has been made concerning self-report scales of alexithymia. The data (1) provide information concerning the psychometric properties of the Schalling-Sifneos Personality Scale (SSPS); (2) present a Minnesota Multi-phasic Personality Inventory (MMPI) subscale for alexithymia based on the SSPS, and (3) provide insight into the relationship between the SSPS and the Beth Israel Questionnaire (BIQ) through a comparison of the MMPI scales derived from the BIQ and the SSPS. Based on these data, suggestions for the quantification of alexithymia are made, as are suggestions for further research on the measurement of alexithymia.
Toxic myopathy induced by the ingestion of loquat leaf extract
Authors: W R Saliba
Journal: Annals of the Rheumatic Diseases (2004)

Loquat ( Eriobotrya japonica ) belongs to the trees of the Rosaceae family. Loquat leaves are widely used in the preparation of oriental herbal teas. In folk medicine, the loquat leaves are used against various skin diseases, cough, nausea, and itching.

Loquat leaves contain ursolic acid and oleanolic acid, which both have hypoglycaemic and antihyperlipidaemic effects in test animals.1–3

We present a patient with hypertriglyceridaemia, who after ingestion of loquat leaf extract had a remarkable decrease in triglycerides and an increase in high density lipoprotein (HDL). However, this benefit was accompanied by toxic myopathy, resembling the effect of HMG-CoA reductase inhibitors and fibric acid derivatives.

A 39 year old man was found to have a high fasting triglyceride level on routine blood testing. The total cholesterol level was normal, and the HDL cholesterol was low. He was otherwise healthy and smoked one packet of cigarettes a day for 5 years. He did not take any drugs, and denied habitual alcohol …
Incidence of Systemic Lupus Erythematosus by Age and Sex
Authors: Robert K. Maddock
Journal: JAMA (1965)

SYSTEMIC LUPUS erythematosus (SLE) has long been regarded as a disease primarily of young women. It is also well known that men develop SLE less frequently, but little attention has been given to the age at which they acquire the malady. Case reviews of patients suffering from SLE at two widely separated teaching hospitals indicated that the disorder is indeed prevalent among young women, but seems to strike men at random with no apparent concentration in any age group. As a result, a review of the literature was undertaken to determine whether this pattern occurred in other series of patients.  Method  The medical records of the University of Virginia Hospital and the Salt Lake County General Hospital were reviewed for all patients with the clinical diagnosis of systemic lupus erythematosus. Only those patients in whom the diagnoses were supported by a positive lupus erythematosus (LE) cell preparation and/or positive autopsy
Manual of Nephrology: Diagnosis and Therapy
Authors: Leonard B. Berman
Journal: JAMA (1981)

Generations of house officers have stretched their pockets with copies of the original spiral manual, the Washington University<i>Manual of Medical Therapeutics</i>. The new generation can no longer use pockets, but needs instead a knapsack to carry around a series that has grown to 28 volumes. One of these is the<i>Manual of Nephrology</i>, edited by Schrier. The virtues of the original therapeutics manual, eg, conciseness, clarity, clinical orientation, and timeliness, have been faithfully reproduced in the present<i>Manual of Nephrology</i>. The preface clearly advises the reader who wants a description of pathophysiology not to look for it here. It is highly relevant, for example, that all 14 chapters have the word "patient" in their titles. The subject matter is appropriate to a nephrology text and includes highly readable descriptions of fluid and electrolyte disturbances, stones, urinary tract infection, renal failure, and renal disease in pregnancy, among others. There is
Treatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society and The Centers for Disease Control and Prevention.
Authors: J B Bass, L S Farer, P C Hopewell, R O'Brien, R F Jacobs, F Ruben, D E Snider, G Thornton
Journal: American Journal of Respiratory and Critical Care Medicine (1994)

Treatment of Tuberculosis. 1. A 6-mo regimen consisting of isoniazid, rifampin, and pyrazinamide given for 2 mo followed by isoniazid and rifampin for 4 mo is the preferred treatment for patients with fully susceptible organisms who adhere to treatment. Ethambutol (or streptomycin in children too young to be monitored for visual acuity) should be included in the initial regimen until the results of drug susceptibility studies are available, unless there is little possibility of drug resistance (i.e., there is less than 4% primary resistance to isoniazid in the community, and the patient has had no previous treatment with antituberculosis medications, is not from a country with a high prevalence of drug resistance, and has no known exposure to a drug-resistant case). This four-drug, 6-mo regimen is effective even when the infecting organism is resistant to INH. This recommendation applies to both HIV-infected and uninfected persons. However, in the presence of HIV infection it is critically important to assess the clinical and bacteriologic response. If there is evidence of a slow or suboptimal response, therapy should be prolonged as judged on a case by case basis. 2. Alternatively, a 9-mo regimen of isoniazid and rifampin is acceptable for persons who cannot or should not take pyrazinamide. Ethambutol (or streptomycin in children too young to be monitored for visual acuity) should also be included until the results of drug susceptibility studies are available, unless there is little possibility of drug resistance (see Section 1 above). If INH resistance is demonstrated, rifampin and ethambutol should be continued for a minimum of 12 mo. 3. Consideration should be given to treating all patients with directly observed therapy (DOT). 4. Multiple-drug-resistant tuberculosis (i.e., resistance to at least isoniazid and rifampin) presents difficult treatment problems. Treatment must be individualized and based on susceptibility studies. In such cases, consultation with an expert in tuberculosis is recommended. 5. Children should be managed in essentially the same ways as adults using appropriately adjusted doses of the drugs. This document addresses specific important differences between the management of adults and children. 6. Extrapulmonary tuberculosis should be managed according to the principles and with the drug regimens outlined for pulmonary tuberculosis, except for children who have miliary tuberculosis, bone/joint tuberculosis, or tuberculous meningitis who should receive a minimum of 12 mo of therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
Selected Characteristics of Graduate Medical Education in the United States
Authors: Beverley Davies Rowley
Journal: JAMA (1991)

For the second year, the Department of Data Systems in the Medical Education Group of the American Medical Association gathered information on graduate medical education primarily by means of an electronic data collection system. Eighty-eight percent of 6622 programs surveyed responded, with 83% reporting detailed information on residents. Analysis of graduate medical education data shows that the number of residents increased by 34.9% from the academic years 1980-1981 to 1990-1991, while the number of graduate year 1 residents decreased by 2%. In the same decade, the proportion of women residents increased by 7.1%. The number of minorities in graduate medical education has grown, but their proportions within the total resident population have remained largely unchanged. The number of graduates from schools of osteopathic medicine has increased by 265% over the same 10-year period. Between 1989 and 1990, a 31.6% increase was recorded in the number of international medical graduates in graduate year 1 residency positions; most of this increase (63.4%) occurred among noncitizens of the United States.
944 HBX interacts with the PCAF acetyltransferase and it is recruited on the HBV CCCDNA to induce a transcriptionally active HBV minichromosome and to activate replication
Authors: T POLLICINO, M DIPADOVA, N PEDICONI, G RAFFA, G SQUADRITO, M FANCIULLI, G RAIMONDO, M LEVRERO
Journal: Hepatology (2003)
Laparoscopic renal biopsy
Authors: Luis F. Gimenez, Salvatore Micali, Roland N. Chen, Robert G. Moore, Louis R. Kavoussi, Paul J. Scheel
Journal: Kidney International (1998)

Renal biopsy continues to be a pivotal tool and frequently indispensable diagnostic procedure in the clinical assessment of proteinuria and or unexplained renal disease. Laparoscopic renal biopsy has recently been reported as an alternative to open renal biopsy.Thirty-two patients who had proteinuria and/or renal insufficiency underwent laparoscopic renal biopsy at our center. The indications for biopsy included failed percutaneous biopsy (N = 3), morbid obesity (14), solitary kidney (5), chronic anticoagulation/coagulopathy (6), religious consideration (refusal of potential blood transfusion) (2), multiple bilateral renal cysts and body habitus (1 case each). The kidney was approached via a laparoscopic retroperitoneal route (retroperitoneoscopy) using a two port technique. The lower pole of the kidney was localized using blunt dissection, laparoscopic cup biopsies were performed, and hemostasis was achieved using standard techniques.All biopsies were successfully completed laparoscopically with sufficient tissue obtained for histopathological diagnosis in all cases. Mean estimated blood loss was 25.9 ml (range 5 to 100). None of the patients required parenteral narcotics during the perioperative period. Operative time ranged from 0.8 to 3.0 hours (mean 1.5). Mean hospital stay was 1.7 days (range 0 to 7). Sixteen patients were treated as outpatients. Patients returned to normal activity at a mean of 1.7 weeks (range 0.3 to 3.0) postoperatively. In one patient, the spleen was inadvertently biopsied without consequence. An additional patient developed a postoperative 300 cc perinephric hematoma that resolved without the need for intervention. One postoperative mortality occurred on postoperative day seven secondary to a perforated peptic ulcer in a patient undergoing high-dose steroid therapy for lupus nephritis.Laparoscopic renal biopsy is a safe, reliable, minimally invasive alternative to open renal biopsy for patients in whom a closed percutaneous approach is either a relative or absolute contraindication, which can be performed on an outpatient basis.
SPARC, a matricellular protein that functions in cellular differentiation and tissue response to injury
Authors: Amy D. Bradshaw, E. Helene Sage
Journal: Journal of Clinical Investigation (2001)

Matricellular proteins SPARC in ECM organizationVertebrate SPARC binds to a number of different ECM components including thrombospondin 1, vitronectin, entactin/nidogen, fibrillar collagens (types I, II, III, and V), and collagen type IV, the prevalent collagen in basement membranes (1).Therefore, SPARC has the potential to contribute to the organization of matrix in connective tissue as well as basement membranes.Interestingly, SPARC is expressed abundantly in basement membranes and in capsules that surround a variety of organs and tissues.In this regard, SPARC-null mice display early cataractogenesis, a phenotype with 100% penetrance (2).Transmission electron microscopy of lens epithelial cells in SPARC-null mice shows an intrusion of cellular processes into the basement membrane of the lens capsule, whereas wild-type lens epithelial cells exhibit a precise border at the cell-matrix interface (3).We have proposed that this phenotype reflects aberrant cell behavior or differentiation resulting from altered composition or structure of the basement membrane formed in the absence of SPARC.
Perspectives of Physicians and Nurse Practitioners on Primary Care Practice
Authors: Karen Donelan, Catherine M. DesRoches, Robert S. Dittus, Peter Buerhaus
Journal: New England Journal of Medicine (2013)

The U.S. health care system is at a critical juncture in health care workforce planning. The nation has a shortage of primary care physicians. Policy analysts have proposed expanding the supply and scope of practice of nurse practitioners to address increased demand for primary care providers. These proposals are controversial.From November 23, 2011, to April 9, 2012, we conducted a national postal-mail survey of 972 clinicians (505 physicians and 467 nurse practitioners) in primary care practice. Questionnaire domains included scope of work, practice characteristics, and attitudes about the effect of expanding the role of nurse practitioners in primary care. The response rate was 61.2%.Physicians reported working longer hours, seeing more patients, and earning higher incomes than did nurse practitioners. A total of 80.9% of nurse practitioners reported working in a practice with a physician, as compared with 41.4% of physicians who reported working with a nurse practitioner. Nurse practitioners were more likely than physicians to believe that they should lead medical homes, be allowed hospital admitting privileges, and be paid equally for the same clinical services. When asked whether they agreed with the statement that physicians provide a higher-quality examination and consultation than do nurse practitioners during the same type of primary care visit, 66.1% of physicians agreed and 75.3% of nurse practitioners disagreed.Current policy recommendations that are aimed at expanding the supply and scope of practice of primary care nurse practitioners are controversial. Physicians and nurse practitioners do not agree about their respective roles in the delivery of primary care. (Funded by the Gordon and Betty Moore Foundation and others.).
633 EVALUATION OF A PREDICTIVE MODEL OF INDIVIDUAL CHANCE FOR SUSTAINED VIROLOGICAL RESPONSE IN PATIENTS WITH CHRONIC HEPATITIS C TREATED WITH PEGINTERFERON ALFA-2A AND RIBAVIRIN
Authors: S. Mauss, D. Hueppe, E. Zehnter, S. Richter, A. Tappe, E. Herrmann
Journal: Journal of Hepatology (2009)
Immunoglobulin E and Immunoglobulin G4 Antibodies to Cow's Milk in Children with Cow's Milk Allergy
Authors: Bengt Björkstéan, Staffan Ahlstedt, Fred Björkstéan, Barbro Carlsson, Sven Petter Fällström, Kaisu Juntunen, Merja Kajosaari, Antta Kober
Journal: Allergy (1983)

The presence of cow's milk specific antibodies of immunoglobulin E and G4 classes were studied in 47 children with a positive clinical history of cow's milk allergy. The children were challenged with cow's milk orally. The clinical diagnosis was verified by immediate reactions in 25 patients while 22 had late reactions or were provocation test negative in spite of the clinical history. There was no relation between levels of cow's milk specific IgG4 antibodies and provocation test result, i.e. neither with immediate or late reactions. Total IgF. Was elevated above + 1 SD for age in 31 41 tested patients. Of these, 29 had immediate type reactions to cow's milk wheat flour and/or egg white, while only two of 10 children with IgE of less than +1 SD had a demonstrable allergy to any of these foods. The sensitivity was 80%. Specific IgE antibodies to cow's milk were demonstrated in 11 of 14 children with immediate reactions and in three of 15 who were provocation test negative or had only late reactions. This means a sensitivity of 79% and a specificity of 80%. At least had only late reactions. This means a sensitivity of 79% and a specificity of 80%. At least one of the four patients with specific IgE but negative provocation test result had earlier shown an immediate reaction when challenged with cow's milk indicating that the specific IgE antibodies were not truly “false” positive reactions but a consequence of previous allergy. Our results confirm an association between elevated total serum IgE and food allergy and an association between positive RAST to cow's milk and positive provocations in young children. We did not find any evidence for specific IgE‐1 antibodies playing a role in these patients.
The Academic Health Center and the Public Agenda: Whose Three-legged Stool?
Authors: Jeremiah A. Barondess
Journal: Annals of Internal Medicine (1991)

The American academic health center has emerged from a tradition that bound research, teaching, and patient care. In recent decades major changes in its faculty array and activities have been generated by extramural funding patterns that have emphasized the research functions of the faculty and, more recently, subspecialty care by faculty members, to the detriment of teaching functions and of immersion in major health care and health promotion issues. The latter are arising more prominently in the public agenda than in the academic agenda. The academic health centers should re-examine their activities with particular attention to the opportunities afforded by this emergent public agenda in biomedicine and health.
Past, present, and the future: Discussions surrounding a new model of sleep-dependent learning and memory processing
Authors: Matthew P. Walker
Journal: Behavioral and Brain Sciences (2005)

Following on from the target article, which presented a new model of procedural skill memory development, in this response I will reflect on issues raised by invited commentators and further expound attributes of the model. Discussion will focus on: evidence against sleep-dependent memory processing, definitions of memory stages and memory systems, and relationships between memory enhancement, sleep-stages, dreaming, circadian time, and sleep-disorders.