tbuckley/cabot-search huggingface dataset:
PTH-142 Does Double Balloon Enteroscopy Affect Management In Patients With Suspected Small Bowel Tumours? Experience From A Single Tertiary Centre: Abstract PTH-142 Figure 1
Authors: MF Hale, ME McAlindon, DS Sanders, R Sidhu
Journal: Gut (2014)

<h3>Introduction</h3> The advent of small bowel capsule endoscopy (CE) has greatly improved the diagnosis of small bowel tumours. Double balloon enteroscopy (DBE) is the interventional counterpart to CE and has the advantage of direct visualisation of small bowel pathology, biopsy and therapeutic capability. There is however a paucity of data on the use of DBE for small bowel tumours. The aim of this study was to assess the utility of DBE for small bowel tumours and to assess its impact on the diagnostic pathway in this cohort. <h3>Methods</h3> Data was collected prospectively on all DBE procedures performed routinely between July 2006 and December 2013 particularly for the indication of small bowel tumours. Patient demographics, clinical presentation, findings at DBE and subsequent follow up data were recorded. The majority of patients had a number of investigations, including radiology, prior to DBE without a firm diagnosis. 83.3% had CE prior to DBE. SPSS V18 was used to analyse the data. <h3>Results</h3> A total of 358 DBE procedures were carried out during the stated time period. Of these procedures, 18 (5.0%) were for the indication of suspected small bowel tumour. The majority (57.1%) of these patients were female and the average age at the time of diagnosis was 58 years (SD±12 y). Indications for performing DBE included iron deficiency anaemia 44.4%, overt bleeding 27.8%, abnormal radiology 22.2% and abdominal pain 5.6%. Of those who had prior CE, CE was positive in 93.3% (14/15) of patients with the presence of a mass lesion (50%), stricture or ulceration (35.7%) or the presence of blood alone (14.3%). Anterograde DBE was performed in 88.9% whilst the remaining number had DBE via the retrograde route. Tumour was successfully identified at DBE in 78% (n = 14) of patients, where tattoos were placed and histology obtained. Of the 4 patients where DBE failed to reach the lesion, the diagnosis was confirmed by laparotomy in 3 patients and intra-operative endoscopy in 1 patient. The final histological diagnosis of tumours identified is shown in Figure 1, UK. 61.1% tumours were located in the jejunum, 27.8% in the ileum and 11.1% in the distal duodenum. DBE influenced ongoing management in all patients that achieved a diagnosis from the procedure. <h3>Conclusion</h3> DBE plays a valuable role in the investigation pathway of patients with suspected small bowel tumours. The step wise approach of CE followed by DBE allows efficient use of small bowel resources. <h3>Disclosure of Interest</h3> None Declared.
Autonomic Failure in Guillain-Barré Syndrome— Value of Swan-Ganz Catheterization
Authors: Michael I. Weintraub
Journal: JAMA (1979)

<h3>To the Editor.—</h3> Idiopathic polyneuritis (Guillain-Barré syndrome) is a distinctive disorder characterized by ascending paralysis, areflexia, and elevated CSF protein. Sudden death is seen, and although there are numerous possibilities in these bedridden patients (eg, myocardial infarction and pulmonary embolism), it has been assumed that the bulk of the fatalities are secondary to respiratory impairment. Evidence is accumulating that autonomic dysfunction is a more critical factor predisposing to sudden death. Using the Swan-Ganz flow-directed balloon-tipped cardiac catheter in a patient with Guillain-Barré syndrome and sudden pulmonary collapse, clinical and physiological observations were made that provided a unique opportunity to determine the role of the autonomic nervous system. <h3>Report of a Case.—</h3> The patient, a previously healthy 67-year-old woman, had severe, rapid-onset Guillain-Barré syndrome that required tracheostomy and respiratory support. Her condition stabilized, and while she was in the intensive care unit, an episode of unresponsiveness with absent blood pressure developed.
Volume and Cellular Content of Normal Pleural Fluid in Humans Examined by Pleural Lavage
Authors: MARC NOPPEN, MARC DE WAELE, RONG LI, KRISTIEN VANDER GUCHT, JAN D'HAESE, ERIK GERLO, WALTER VINCKEN
Journal: American Journal of Respiratory and Critical Care Medicine (2000)

Currently, no reliable data are available on the volume or on the cellular content of pleural fluid in normal humans. In analogy with bronchoalveolar lavage (a technique enabling retrieval of small volumes of epithelial lining fluid from the lung), we developed a pleural lavage (PL) technique consisting of injection and retrieval of 150 ml of saline into the right pleural space, performed during a thoracoscopic sympathicolysis procedure in otherwise healthy subjects suffering from essential hyperhidrosis. With urea used as an endogenous marker of dilution, measured mean right-sided pleural fluid volume was 8.4 ± 4.3 ml. In a subgroup of subjects, we confirmed that right- and left-sided pleural fluid volumes were similar. Expressed per kilogram of body mass, total pleural fluid volume in normal, nonsmoking humans is 0.26 ± 0.1 ml/kg. Total cell count in the PL fluid of nonsmoking normal subjects yielded a median of 91 × 103 white blood cells (WBC) per milliliter of lavage fluid (interquartile range [IR] = 124 × 103 cells/ml). Taking into account a measured dilution factor of 18.86, the total WBC count in the original pleural fluid was 1,716 × 103 cells/ml. Differential cell counts yielded a predominance of macrophages (median: 75%; IR: 16%) and lymphocytes (median: 23%; IR: 18%). Mesothelial cells (median: 1%; IR: 2%), neutrophils (median: 0%; IR: 1%), and eosinophils (median: 0%; IR: 0%) were only marginally present. There were no significant differences between males and females or between right- and left-sided pleural fluid in total and differential cell counts. In contrast, in smokers a small but statistically significant increase in pleural fluid neutrophils (median: 1%; IR: 2%; p < 0.015) was observed. In conclusion, PL performed during thoracoscopy for sympathicolysis allowed for the first time determination of the volume and of the total and differential cell contents of the pleural fluid present in normal human pleura.
Smoking a Single Cigarette Rapidly Reduces Combined Concentrations of Nitrate and Nitrite and Concentrations of Antioxidants in Plasma
Authors: Masahiko Tsuchiya, Akira Asada, Emiko Kasahara, Eisuke F. Sato, Mitsuo Shindo, Masayasu Inoue
Journal: Circulation (2002)

Background — Cigarette smoking is a well-known risk factor for the development of cardiovascular disease, yet the mechanism of action involved is not completely understood. Because cigarette smoke contains superoxide and other reactive oxygen species, it has been hypothesized that some of the adverse effects of smoking may result from oxidative damage to endothelial cells, which results in nitric oxide (NO) shortage. However, little information is available regarding the acute effects of smoking on plasma concentrations of NO and antioxidants. We measured the changes in the combined plasma concentrations of nitrate and nitrite as an index of NO concentration, as well as changes in concentrations of major serum antioxidants (ascorbic acid, cysteine, methionine, and uric acid) in smokers after smoking a single cigarette. Methods and Results — A randomized crossover study of the effects of smoking a single cigarette was performed in 20 smokers. Smoking a sham cigarette induced no significant changes in all assayed parameters. However, smoking a single cigarette significantly decreased nitrate and nitrite plasma concentrations by 3.5±1.2 and 3.4±1.1 μmol/L, compared with plasma concentrations at presmoking and sham smoking, respectively. The concentrations of ascorbic acid and other antioxidants were also significantly lower after smoking a single cigarette. These parameters returned to preexperimental levels 60 minutes after smoking cessation. Conclusion — The present findings indicate that smoking a single cigarette temporarily decreases nitrate, nitrite, and serum antioxidant concentrations in the plasma. These transient changes may partially contribute to coronary vasoconstriction, which is routinely observed after smoking.
Misuse of prescription drugs could soon exceed that of illicit narcotics, UN panel warns
Authors: John Zarocostas
Journal: BMJ (2007)

Cyclo-oxygenase-2 (COX 2) inhibitors should be used only as the last choice after other types of non-steroidal anti-inflammatory drugs (NSAIDs) to relieve chronic pain in people with heart disease or at high risk of it, the American Heart Association has recommended.Its statement, published online in Circulation on 26 February (http://circ.ahajournals.orgdoi:10.1161/circulationaha.106.181424), was designed to end any remaining confusion about the cardiovascular risk of these agents.The association has recommended a stepped approach to treatment.The first step should be non-pharmacological approaches, such as physical therapy and weight loss, for patients with known cardiovascular disease or with risk factors for ischaemic heart disease.Drug treatment should start with agents with the lowest reported risk of cardiovascular events, before other agents are prescribed, and at each step account should be taken of the risk-benefit balance.First line drug choices include paracetamol (acetaminophen), aspirin, tramadol, and short term use of other narcotic analgesics.If these fail to achieve adequate pain control, the next option is non-acetylated salicylates, such as naproxen.The association recommended NSAIDs that aren't COX 2 inhibitors if pain is still inadequately controlled, then NSAIDs with some COX 2 activity as the next step, and lastly COX 2 selective NSAIDs.The committee considered the risk of all three of these classes to be sufficiently high to require that patients taking them should be monitored regularly for sustained hypertension (or worsening of prior blood pressure control), oedema, worsening renal function, or gastrointestinal bleeding.See pp 436, 450. Save COX 2 inhibitors till last for cardiac patientsUK NEWS HFEA allows women to donate eggs for research, p445 World NEWS repeal law that puts "FdA on the payroll of the industry", p447 bmj.comUK government defeated on community treatment forms
Amyloid tumor of the stomach simulating an obstructing gastric carcinoma: case report and review of the literature
Authors: J. Losanoff, F. Antaki, W. Salwen, D. Edelman, A. Reddy, E. Levi, M. Basson
Journal: Endoscopy (2009)

Systemic amyloidosis is known to rarely affect the stomach [1] [2] [3] [4] [5]. A 59-year-old male patient presented with intermittent nausea, vomiting, daily bowel movements, and weight loss of 20 kg over 2 months. His past medical history was significant for arterial hypertension, prostate cancer for 10 years, multiple myeloma, and recent renal failure. Barium upper gastrointestinal X-ray series revealed a large constricting lesion in the gastric antrum and proximal duodenum suggestive of malignancy ([Fig. 1]). Upper gastrointestinal endoscopy revealed a large, fungating, friable mass which obstructed nearly 75 % of the prepyloric lumen ([Fig. 2]). Pathological analysis of the biopsies revealed amyloid deposits on the muscularis mucosae.
Screening Strategies for Early Detection of Lung Cancer
Authors: Thomas L. Petty
Journal: JAMA (2000)

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
Effects of chronic hypertension and left ventricular hypertrophy on the incidence of sudden cardiac death after coronary artery occlusion in conscious dogs.
Authors: S Koyanagi, C Eastham, M L Marcus
Journal: Circulation (1982)

When acute myocardial infarction occurs in patients with hypertension and left ventricular hypertrophy (LVH), the incidence of sudden cardiac death increases markedly. Possible explanations include increased size of the occluded vascular bed secondary to more extensive atherosclerotic coronary vascular disease in the presence of hypertension, decreased coronary reserve secondary to LVH, and intrinsic electrophysiologic abnormalities in hypertrophied cardiac muscle. To explore these possibilities, we produced acute circumflex coronary occlusion during the resting, conscious state in 32 control dogs and in 28 dogs with hypertensive LVH. Before coronary occlusion, mean arterial pressure was 96 +/- 0.1 mm Hg in control dogs and 125 +/- 5 mm Hg in dogs with hypertensive LVH (p less than 0.01). The control left ventricular/body weight ratio was 4.5 +/- 0.1 g/kg, compared with 6.1 +/- 0.1 g/kg in hypertensive LVH (p less than 0.01). Cumulative mortality at 6, 24 and 48 hours was 9%, 13% and 16% in control dogs and 32%, 43% and 54%, respectively, in dogs with hypertensive LVH (all p less than 0.01 vs control). The perfusion fields of the occluded vessel defined by postmortem coronary angiography were similar in the two groups (31 +/- 2% of left ventricular mass for control vs 29 +/- 2% for hypertensive LVH). Thus, the increased incidence of sudden cardiac death after coronary artery occlusion in hypertensive LVH dogs cannot be explained by increased size of the occluded vascular bed and is probably related to the decreased coronary reserve or intrinsic electrophysiologic abnormalities that characterize pressure-induced hypertrophied cardiac muscle.
Frequency analysis of the surface electrocardiogram for recognition of acute rejection after orthotopic cardiac transplantation in man.
Authors: R Haberl, M Weber, H Reichenspurner, B M Kemkes, G Osterholzer, M Anthuber, G Steinbeck
Journal: Circulation (1987)

Recognition of acute rejection after heart transplantation has been based mainly on invasive methods until now. In this study we analyzed two well-defined surface electrocardiographic recordings by fast Fourier transform (FFT) (Blackman Harris window, 512 points) after low-noise, high-gain amplification (filter setting 0.5 to 300 Hz) each day for 4 weeks after cardiac transplantation in 27 patients. Twenty acute rejection crises requiring treatment were diagnosed by cytoimmunologic monitoring and endomyocardial biopsy. Single-beat analysis of the QRS complex by FFT revealed a progressive change of the spectral morphology (increase of the frequency content between 70 and 110 Hz) on the days of rejection in 19 of 20 patients. At that time there were no visible changes on the electrocardiogram in the time domain in most patients. At the same time, the frequency content of the ST segment decreased between 10 and 30 Hz in 16 of 20 patients. After successful treatment, the frequency spectra of the QRS complex and ST segment returned to control within 1 to 2 weeks in most patients. One false-positive result was seen in a patient with mediastinitis and large pericardial effusion. A drop in QRS amplitude (greater than 20%) occurred in 10 of 20 rejection crises and in 10 patients without rejection. Nine patients after cardiac transplantation without rejection and seven control patients after cardiac surgery (not transplantation) showed stable frequency plots from one day to the other after the first postoperative day, but with considerable changes in QRS amplitude.(ABSTRACT TRUNCATED AT 250 WORDS)
Social Class and Child Psychiatric Practice: The Clinician's Evaluation of the Outcome of Therapy
Authors: JOHN F. McDERMOTT, SAUL I. HARRISON, JULES SCHRAGER, ELIZABETH W. KILLINS, BARBARA DICKERSON
Journal: American Journal of Psychiatry (1970)

Data from the evaluation and treatment of 364 lower-, lower middle-, and upper middle-class children were compared. There was no significant difference among the three groups as to perceived improvement at termination of treatment, but longer duration of treatment was associated with greater improvement in the upper middle-class group compared with the other two. While the findings did not indicate class-related differences in basic treatment approach, they did point up subtle difficulties in application of traditional therapeutic modes to lower middle-class and lower-class patients.
Evidence that 1,25-dihydroxyvitamin D3 inhibits the hepatic production of 25-hydroxyvitamin D in man.
Authors: N H Bell, S Shaw, R T Turner
Journal: Journal of Clinical Investigation (1984)

Previous in vitro studies in rachitic rat liver suggested that 1,25-dihydroxyvitamin D inhibits the hepatic production of 25-hydroxyvitamin D (25-OHD). An investigation therefore was carried out in eight normal subjects to determine whether concomitant administration of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] would alter the response of serum 25-OHD to challenge with vitamin D. In control studies, vitamin D, 100,000 U/d for 4 d, significantly increased mean serum 25-OHD, from 26.3 +/- 2.9 to 66.7 +/- 12.6 ng/ml (P less than 0.01). In contrast, 1,25(OH)2D3, 2 micrograms/d for 4 d, completely prevented an increase in serum 25-OHD in response to the same dose of vitamin D in the same individuals (25.1 +/- 2.2 vs. 27.4 +/- 5.3 ng/ml, NS). In a post-control study in seven of the normal subjects, vitamin D again significantly increased mean serum 25-OHD, from 18.2 +/- 3.1 to 42.8 +/- 4.7 ng/ml (P less than 0.001). In each of the three studies, mean serum calcium, phosphorus, and creatinine did not change and remained within the normal range. Whereas mean urinary calcium did not change in response to vitamin D alone during the 4 d of the two control studies, it increased significantly in the study in which vitamin D and 1,25(OH)2D3 were given together. A dose-response inhibition of the response of serum 25-OHD to vitamin D by 1,25(OH)2D3 was demonstrated in two of the normal subjects. The results provide evidence that 1,25(OH)2D3 inhibits the hepatic synthesis of its precursor 25-OHD in man.
Gain-of-function signal transducer and activator of transcription 1 (STAT1) mutation–related primary immunodeficiency is associated with disseminated mucormycosis
Authors: Nilay Kumar, Mary E. Hanks, Prabha Chandrasekaran, Brian C. Davis, Amy P. Hsu, Nicholas J. Van Wagoner, Jessica S. Merlin, Christine Spalding, Ricardo M. La Hoz, Steven M. Holland, Christa S. Zerbe, Elizabeth P. Sampaio
Journal: Journal of Allergy and Clinical Immunology (2014)
Lehrbuch der Gynäkologie
Authors: S. B. Gusberg
Journal: JAMA (1964)

This standard comprehensive textbook of gynecology for medical students and practitioners, now in its eighth edition, was written by the dean of German gynecologists, at present emeritus professor at the University of Göttingen. From such a distinguished teacher one would expect just such a thorough exposition of clinical gynecology and its allied fields, with emphasis on diagnosis and treatment, supported by numerous excellent teaching diagrams. The chapters on dysfunctional bleeding and malpositions are notable examples of this excellent style of traditional gynecologic teaching, and the same comprehensiveness may be noted in the sections on gynecologic examination, urology, and orthopedics. Professor Martius has introduced with benefit some aspects of the modern knowledge of genetics and psycho-emotional problems into this "classical" presentation, but I think the medical student could derive still further stimulation from some expansion of the sections concerned with reproductive physiology and gynecologic pathology where the text and the illustrative
Single definition of overweight and obesity should be used
Authors: S. A Jebb, A. M Prentice
Journal: BMJ (2001)

EDITOR—In May 2000 the BMJ published details of a new reference standard for childhood obesity developed by the International Obesity Task Force.1 The task force's standards take a logical and pragmatic approach to the problem of defining the cut-off points of body mass index indicating overweight and obesity in children.

In adults these cut-off points are based on the morbidity and mortality associated with excess weight. In the absence of such data in children the task force defined the cut-off points for young people …
Simple Modifications of the Current Curriculum To Enhance Educational Experience
Authors: Harold J. Fallon
Journal: Annals of Internal Medicine (1992)

Changes in medical practice and in the financing of hospital care have resulted in a narrowing spectrum of adult medical illness among hospitalized patients. Residency training based primarily in the hospital underemphasizes many diseases and disorders that are treated exclusively at ambulatory sites. Curriculum modifications should allow for increased training time for residents in the ambulatory care setting. Reducing clinical inpatient service demands on residents and alleviating the attendant stress will allow more time for such educational experiences. The Medical College of Virginia has had recent experience with three modifications to the curriculum, which are intended to accomplish these ends: a specialized unit for inpatient services, which is not staffed by interns; a reorganization of the daily inpatient care schedule; and a modified "night float" team.
Atlas of Blood Cells: Function and Pathology
Authors: William G. Hocking
Journal: JAMA (1989)

This two-volume work is a beautiful demonstration of the integration of classic morphological hematology with modern molecular techniques for the study of hematologic diseases. The second edition of this work appears 7 years after the first, and there are a number of substantial changes. The number of contributors has increased from 13 to 19. New chapters have been added on dendritic or antigen processing cells and the hematopathology of the acquired immunodeficiency syndrome. Other chapters have been extensively rewritten and updated. There is an excellent overview of hematopoiesis and hematopoietic growth factors. The chapter on cellular identification and markers is a useful and well-illustrated review of the many available techniques used in phenotypic analysis of hematologic cell populations. The section on acute myelogenous leukemia is updated and includes the megakaryocytic (M7) variant. Likewise, the acute lymphoblastic leukemia section is extensively revised, particularly in regard to the phenotypic characteristics defined by
Removal of Hemorrhoids
Authors: Norman W. Frink
Journal: JAMA (1968)

<h3>To the Editor:—</h3> In the presentation of our experience with the ligation treatment of internal hemorrhoids, we assumed it would be understood that a sigmoidoscopic and barium enema examination had been done before we elected to treat a patient with hemorrhoids. We specifically stated that the technique was applicable only to people with symptomatic internal hemorrhoids without other coexisting rectal conditions. In our experience, now running to over 150 patients, it has proven to be a most satisfactory method of treatment. The patients are pleased with the results and so are we. We still do an occasional hemorrhoidectomy, however.