tbuckley/cabot-search huggingface dataset:
PWE-051 What is the True Incidence of Lymphocytic and Collagenous Colitis?
Authors: L Stevens, G Kaur
Journal: Gut (2013)

<h3>Introduction</h3> Increased incidence of both lymphocytic (LC) and collagenous (CC) colitis, often described under the umbrella term of microscopic colitis (MC), is being seen globally. The aetiology, pathogenesis and incidence of MC is yet to be well established. However, not all patients with diarrhoea undergo biopsies to cheque for MC. We aimed to investigate our patient population attending for colonoscopy with symptoms of diarrhoea to assess the proportion of patients undergoing random colon/rectal biopsies to look for MC as well as the incidence of LC/CC in our population. <h3>Methods</h3> Retrospective analysis of the endoscopy database was performed to identify patients presenting from January - December 2011 for colonoscopy with diarrhoea. Patients with a complete colonoscopy with macroscopically normal mucosa or findings unrelated to symptoms were included. MC patients were identified by histology. <h3>Results</h3> A total of 939 colonoscopies were performed during this period for either diarrhoea or undocumented symptoms. Of these, 186 were for patients with definite diarrhoea and were both complete as well as macroscopically normal. Of these, 123 (66%) had random biopsies taken. 2 patients i.e 1% of all diarrhoea patients undergoing colonoscopy (1.6% of all diarrhoea patients undergoing colonoscopy <i>and</i> random biopsies) were diagnosed with CC while 5 patients i.e 2.7% of all diarrhoea patients undergoing colonoscopy (4.1% of all diarrhoea patients undergoing colonoscopy <i>and</i> random biopsies) were diagnosed with LC. Thus, 3.8% of all diarrhoea patients undergoing colonoscopy were diagnosed with MC (5.7% of all diarrhoea patients undergoing colonoscopy <i>and</i> random biopsies). <h3>Conclusion</h3> Though there appears to be an increase in incidence of MC documented in literature, we did not find this in our endoscopy unit. This may be due to variability in endoscopists resulting in inadequate random biopsies being undertaken during colonoscopy performed to investigate diarrhoea. We are currently undertaking an audit to ensure improved management of these patients as well as improve our accuracy in the assessment of the true incidence of MC. <h3>Disclosure of Interest</h3> None Declared. <h3>Reference</h3> Fernández-Bañares F, Salas A, Forné M, Esteve M, Espinós J, Viver JM. Incidence of collagenous and lymphocytic colitis: a 5-year population-based study. Am J Gastroenterol. 1999 Feb; 94(2):418–23.
Consultants do sexy audit
Authors: C. M. Turner, T. M. Bentley, J. A. Crampton, S. Rahman
Journal: BMJ (2010)

Most staff in hospitals find saving lives “sexy,”1 and audit can be a major driver.

As junior doctors in various hospitals we performed audit on numerous occasions. It was dull, predictable, rarely resulted in significant change in practice, and was generally regarded as a morning off for us. As consultants in …
Clinical management of stuttering in children and adults
Authors: S. O'Brian, M. Onslow
Journal: BMJ (2011)

#### Summary points

Stuttering, also known as stammering, is a common speech disorder of neural speech processing that typically begins during the first years of life. An Australian cohort study (n=1619) of children recruited at 8 months of age found that 8.5% had begun to stutter a 36 months of age, and 12.2% by 48 months.1 A review of 44 studies shows a prevalence of around 1% for schoolchildren worldwide (range 0.03-5.2%).w1 Stuttering is essentially a movement disorder of speech, with observable effects on the jaw and mouth, but also facial muscles and sometimes upper limbs. Those who stutter are at risk of developing social anxiety or mental health problems.

Evidence from randomised trials has shown that treatment before 6 years of age reduces the chance of stuttering becoming intractable. Children can recover without formal intervention, but it is not possible to predict who will recover spontaneously. It is therefore best to take advantage of the window of opportunity within which children may be treated with best effect, which is within one year of onset. For adults with long term stuttering, early randomised trials of behavioural and cognitive interventions show promise.

#### Sources and selection criteria

We consulted our own archive and searched the Institute …
Use of Seat Belts
Authors: Jaydev R. Varma
Journal: JAMA (1983)

To the Editor.—  I am in agreement with Dr Roger P. Smith's concern regarding the underuse of seat belts (1982;248:922). As the small study he conducted demonstrates, it is a sad state of affairs to see such a neglect of an easy to use and inexpensive device related to injury prevention.  I wonder how many physicians ever use seat belts or how many require or insist that their families use seat belts. Physicians can modify patient attitudes to some extent by being more open and vocal about the advantages of wearing seat belts when talking to their patients.  It would also benefit physicians and their assistants involved in patient care and particularly patient education to have a good understanding of the correct method of wearing seat belts. Considering that almost 50,000 to 60,000 persons are killed on the highways in the United States annually and also that the majority of
Duplication of the Cystic Duct Detected by Endoscopic Retrograde Cholangiopancreatography
Authors: Y. Kubota
Journal: Endoscopy (1991)

See also: The Bile Duct System and its Anatomical VariationsEndoscopy 1989; 21(S 1): 300-308DOI: 10.1055/s-2007-1012978
Portal and systemic haemodynamic action of N-acetylcysteine in patients with stable cirrhosis.
Authors: A L Jones, I H Bangash, I A Bouchier, P C Hayes
Journal: Gut (1994)

The effects of intravenous N-acetylcysteine on hepatic and systemic haemodynamics were investigated in 11 patients with stable cirrhosis (eight alcohol; two primary biliary cirrhosis; one cryptogenic). N-acetylcysteine administration had no effect on the mean heart rate or mean arterial blood pressure despite a significant fall in systemic and pulmonary vascular resistance. Cardiac index increased but estimated liver blood flow and portal venous pressure did not change significantly. Administration of N-acetylcysteine resulted in increased oxygen delivery to the tissues because of the increased cardiac index but this was not accompanied by a rise in either arteriovenous oxygen extraction ratio or mean tissue oxygen consumption. Therefore N-acetylcysteine administration seems to confer no haemodynamic benefit to patients with cirrhosis.
Potassium Modulates Electrolyte Balance and Blood Pressure through Effects on Distal Cell Voltage and Chloride
Authors: Andrew S. Terker, Chong Zhang, James A. McCormick, Rebecca A. Lazelle, Chengbiao Zhang, Nicholas P. Meermeier, Dominic A. Siler, Hae J. Park, Yi Fu, David M. Cohen, Alan M. Weinstein, Wen-Hui Wang, Chao-Ling Yang, David H. Ellison
Journal: Cell Metabolism (2015)

Dietary potassium deficiency, common in modern diets, raises blood pressure and enhances salt sensitivity. Potassium homeostasis requires a molecular switch in the distal convoluted tubule (DCT), which fails in familial hyperkalemic hypertension (pseudohypoaldosteronism type 2), activating the thiazide-sensitive NaCl cotransporter, NCC. Here, we show that dietary potassium deficiency activates NCC, even in the setting of high salt intake, thereby causing sodium retention and a rise in blood pressure. The effect is dependent on plasma potassium, which modulates DCT cell membrane voltage and, in turn, intracellular chloride. Low intracellular chloride stimulates WNK kinases to activate NCC, limiting potassium losses, even at the expense of increased blood pressure. These data show that DCT cells, like adrenal cells, sense potassium via membrane voltage. In the DCT, hyperpolarization activates NCC via WNK kinases, whereas in the adrenal gland, it inhibits aldosterone secretion. These effects work in concert to maintain potassium homeostasis.
Low-dose methotrexate in PAH related to T-cell large granular lymphocyte leukaemia
Authors: O. Grossi, D. Horeau-Langlard, C. Agard, A. Haloun, M. Lefebvre, A. Neel, M.A. Hamidou
Journal: European Respiratory Journal (2012)

To the Editors:

The classification of pulmonary hypertension (PH) has recently been updated and PH associated with haematological disorders is classified as category V [1].

T-cell large granular lymphocytes (LGLs) are a morphologically distinct subset of normal peripheral blood mononuclear cells classified into two major lineages based on the presence of the CD3 receptor: CD3+ lymphocytes and CD3- natural killer cells. The revised European-American classification of lymphoid neoplasms [2] considers clonal proliferation of these cells, or LGL leukaemia (as proved by a cytogenetic study of the rearrangement of the T-cell receptor), as a distinct type of peripheral T-cell neoplasm. In the vast majority of cases, LGL leukaemia has a CD3+, αβ+, CD4-, CD8+, CD16+, CD57+ and CD56- phenotype and an indolent course [3]. Overexpression of some natural killer receptors (NKRs) of the killer immunoglobulin-like receptor family, such as CD94 and CD158b, is sometimes observed [4–6]. T-cell LGL leukaemia is frequently associated with various autoimmune diseases, particularly rheumatoid arthritis (30% of cases) and haematological disorders ( e.g. neutropenia) [3].

PH associated with T-cell LGL leukaemia has been described in rare cases and an aetiopathological link between the diseases has been suggested [4–8]. In this context, the efficacy of immunosuppressive agents in association with standard treatment (oral anticoagulants±diuretics±oxygen) with or without vasodilatory drugs has been investigated [4, 6, 7].

Herein, we describe a new case of PH associated with T-cell LGL leukaemia that responded to immunosuppressive therapy. Possible aetiopathological mechanisms are discussed on the basis of literature data.

A 50-yr-old female without significant medical history was admitted to hospital because of rapidly progressive New York Heart Association (NYHA) functional class …
Ophthalmic surgical training
Authors: R. Smith
Journal: Journal of the Royal Society of Medicine (2004)

One conclusion drawn from the survey in the April JRSM1 is that senior house officers (SHOs) in ophthalmology get more experience in teaching hospitals than in district general hospitals (DGHs). I take issue with this interpretation of the data. Competition for SHO posts in teaching hospitals is particularly intense, and the usual route of entry to these posts is via a ‘good’ DGH ophthalmic SHO post offering plenty of surgical training. Although no details are given in the paper, I imagine that most of the neophyte SHOs (less than 12 months' experience) were in DGH posts. Given that teaching hospital SHOs are likely to be a selected population in terms of previous surgical experience, the study may overestimate the quality of surgical training provided in teaching hospitals. The Royal College of Ophthalmologists requires that, after the first two years of training, a minimum of 50 phaco operations per year should be performed. It would have been interesting to know what proportion of 3rd and 4th year SHOs were achieving this standard.

Protected surgical teaching time can be quantified as the difference between the time allocated to the list and the time the trainer would take to complete the list without the trainee. A reasonable minimum at SHO level is an hour of protected surgical training time per SHO per week. The College requirements should be achievable at this level of exposure, and there is no reason why training agreements between postgraduate deans and trusts cannot specify it, with financial sanctions for trusts that short-change their trainees persistently.
Middle Class Too Feels Loss of Health Insurance
Authors: Charles Marwick
Journal: JAMA (1994)

FOR ONE reason or another, some 2.25 million Americans, on average, have their health insurance policies canceled every month, according to a new report,<i>How Americans Lose Health Insurance</i>. The report was released at a press conference on Capitol Hill by Families USA Foundation, a Washington, DC—based consumer group working for health system reform. The majority of the people who lose their insurance manage to reacquire health insurance coverage, but their new policy may not provide the same benefits as the old one. In any event, there is an interim period when they "go bare." It takes about 5 months or less for half of those who lost their health insurance coverage to get it back, says the report. The report is based primarily on data from the 1990 Survey of Income Program Participation conducted by the Bureau of the Census. Health insurance status is reported for five types of
Granuloma annulare restricted to Becker's naevus
Authors: J.M. Weinberg, N. Scheinfeld, H.R. Tishler
Journal: British Journal of Dermatology (2004)

Journal Article Granuloma annulare restricted to Becker's naevus Get access J.M. Weinberg, J.M. Weinberg Department of Dermatology, St Luke's‐Roosevelt Hospital Center, 1090 Amsterdam Avenue, Suite 11D, and Beth Israel Medical Center, New York, NY 10025, U.S.A. E‐mail: jmw27@columbia.edu Search for other works by this author on: Oxford Academic Google Scholar N. Scheinfeld, N. Scheinfeld Department of Dermatology, St Luke's‐Roosevelt Hospital Center, 1090 Amsterdam Avenue, Suite 11D, and Beth Israel Medical Center, New York, NY 10025, U.S.A. E‐mail: jmw27@columbia.edu Search for other works by this author on: Oxford Academic Google Scholar H.R. Tishler H.R. Tishler Department of Dermatology, St Luke's‐Roosevelt Hospital Center, 1090 Amsterdam Avenue, Suite 11D, and Beth Israel Medical Center, New York, NY 10025, U.S.A. E‐mail: jmw27@columbia.edu Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 151, Issue 1, 1 July 2004, Pages 245–246, https://doi.org/10.1111/j.1365-2133.2004.06049.x Published: 01 July 2004
Aleukemic leukemia cutis
Authors: Sayoko Ohno, Tadashi Yokoo, Miyuki Ohta, Masamitsu Yamamoto, Kiichiro Danno, Noriyuki Hamato, Keisuke Tomii, Yohichiroh Ohno, Yoichiro Kobashi
Journal: Journal of the American Academy of Dermatology (1990)
CHRONIC BRIGHT'S DISEASE (ARTERIO-CAPILXARY FIBROSIS) IN ITS RELATIONS TO INSANITY.
Authors: E. A. CHRISTIAN
Journal: JAMA (1889)

Efforts to frame a satisfactory etiological classification of mental disease have been materially helped by a resort to a clinical grouping of cases. It has been recognized that where a wide variation exists in the causes assigned for the production of insanity in any given series of cases, among certain of them "groups of symptoms" are manifested which point to a definite constantly acting cause. "In many instances we know absolutely that such a cause exists. Even if we do not know that a specific cause is antecedent to the development of a certain form of disease, we are justified in inferring, where symptoms are identical, an identity of cause." Acting upon this theory, it has been possible to frame a rational classification or "clinical grouping" that has simplified much that has hitherto been unsatisfactory and obscure. In spite, however, of the material assistance thus afforded, the lack of a
Fetuin-A gene expression, synthesis and release in primary human hepatocytes cultured in a galactosylated membrane bioreactor
Authors: Bruno Memoli, Loredana De Bartolo, Pietro Favia, Sabrina Morelli, Linda C Lopez, Alfredo Procino, Giuseppe Barbieri, Efrem Curcio, Lidietta Giorno, Pasquale Esposito, Mario Cozzolino, Diego Brancaccio, Vittorio E Andreucci, Riccardo d'Agostino, Enrico Drioli
Journal: Biomaterials (2007)
Antibodies against cyclic citrullinated peptide (CCP) in psoriatic patients with or without joint inflammation
Authors: G M Alenius
Journal: Annals of the Rheumatic Diseases (2005)

<b>Objective:</b> To compare the prevalence of anti-CCP antibodies in psoriatic patients with and without joint inflammation, patients with early RA, and controls. <b>Methods:</b> Anti-CCP antibodies (cut off level 5 U/ml) were measured in 160 patients with psoriatic arthritis (PsA), 146 patients with psoriasis but no arthritic disease, 101 patients with early RA, and 102 healthy controls by ELISA. <b>Results:</b> 11 (7%) patients with PsA, 75 (74%) patients with early RA, 2 (2%) healthy controls (2%), and 1 (0.7%) patient with psoriasis without arthritis had anti-CCP antibodies above the cut off level. The presence of anti-CCP antibodies was not related to radiological changes and/or deformity and functional impairment in PsA. 8/11 patients with PsA and anti-CCP antibodies had a polyarthritic disease, and all fulfilled the ACR criteria for RA at 4 year follow up. Five of these 8 patients also had manifestations such as dactylitis, DIP involvement, radiological changes associated with PsA, and/or enthesitis. In multiple logistic regression analysis with polyarthritis as the dependent variable, anti-CCP antibodies and rheumatoid factor significantly distinguished RA from PsA. <b>Conclusions:</b> Anti-CCP antibodies were more prevalent in patients with PsA than in patients with psoriasis without arthritis, but less prevalent than in patients with early RA. Patients with PsA positive for anti-CCP antibodies more often had polyarthritic disease, but the presence of anti-CCP antibodies did not relate to radiological changes and/or deformity and functional impairment.
Early life risk factors for obesity in childhood: Authors' reply
Authors: John J Reilly, Julie Armstrong, Pauline Emmett, Andy Ness, Andrea Sherriff
Journal: BMJ (2005)

Prognosis in obesity Older people should not be misinformed about being overweightEditor-With reference to the editorial by Lean on prognosis in obesity, 1 advising apparently overweight older people to lose weight may do more harm than good.Evidence suggests that the risks of being "overweight" decrease with increasing age.On the basis of mortality, the ideal body mass index (BMI) is higher in older than young adults, with an optimum BMI for people older than 65 in the young adult "overweight" range of 27-30 kg/m 2 . 2 In a systematic review, Heiat et al concluded that the relation between BMI and mortality in people older than 65 is a flat bottomed, Ushaped curve, with mortality rising only at BMI > 31 kg/m 2 and perhaps not at any BMI in people older than 75. 2 Weight loss is more common than weight gain in older people, and associated with poor outcomes, even when the weight loss is intentional and the person was "overweight" at baseline. [3]4][5] In the prospective cardiovascular health study of some 4700 community dwelling people older than 65, weight loss of more than 5% over three years was substantially more common than weight gain of more than 5%. 3 Weight loss, but not weight gain, was associated with a significantly increased risk of mortality (relative risk 1.67, 95% confidence interval 1.29 to 2.15). 3 The association of increased mortality with weight loss persisted even at the highest third of baseline weight. 3 In a study of older men with BMI ≥ 30 kg/m 2 , intentional weight loss was associated (P < 0.001) with a greater rate of hip bone loss ( -1.7%/year) than in men with no weight loss ( -0.1%/year) or weight gain (0.5%/year). 5 The indiscriminate application of evidence from studies in younger adults to the management of older people is hazardous.We believe that many older people are trying to lose weight inappropriately.There is a need to ensure that most of our elders are given appropriate advice: "Keep physically active, eat sensibly, and maintain weight."
Cervical Spondylotic Dysphagia
Authors: Vijay K. Gohel
Journal: JAMA (1976)

HYPERTROPHIC spurs along the cervical spine may cause varying degrees of dysphagia. In its severe form, it may simulate a neurogenic disorder or a tumor. Recently, we have examined several such patients, one of whom showed virtually all the clinical, endoscopic, and roentgenographic findings so far reported with this condition.<sup>1-5</sup>A new finding of Zenker diverticulum was also observed in this case. <h3>Report of a Case</h3> An 80-year-old man was examined in the radiology department for gradually increasing dysphagia of solid foods for ten years. The patient was well developed and well nourished. He denied losing any weight. The only noteworthy past history was his previous admission in 1967 for a similar complaint. He underwent esophagoscopy because of a preoperative diagnosis of possible pharyngeal carcinoma. At that time, fullness in the posterior pharyngeal wall appeared to be smooth and without ulceration. Fluoroscopy at the last visit showed gross disturbance
Are they relevant? A critical evaluation of the international classification of functioning, disability, and health core sets for osteoarthritis from the perspective of patients with knee osteoarthritis in Singapore
Authors: Feng Xie, Julian Thumboo, Kok-Yong Fong, Ngai-Nung Lo, Seng-Jin Yeo, Kuang-Ying Yang, Shu-Chuen Li
Journal: Annals of the Rheumatic Diseases (2006)

To determine the extent to which health items identified from the perspective of patients with knee osteoarthritis can be linked with the International Classification of Functioning, Disability and Health (ICF); and to evaluate critically the content validity of ICF comprehensive and brief core sets for osteoarthritis.
Glomerular permeability of macromolecules. Effect of molecular configuration on the fractional clearance of uncharged dextran and neutral horseradish peroxidase in the rat.
Authors: H G Rennke, M A Venkatachalam
Journal: Journal of Clinical Investigation (1979)

Molecular parameters other than size and charge are likely to influence the filtration of macromolecules across the glomerular filter. We have studies, therefore, the glomerular permeability of macromolecules with widely different molecular configuration such as horseradish peroxidase, a plant glycoprotein with an isoelectric point in the physiologic pH range, and dextran, an uncharged sugar polymer of D-glucopyranose. Simultaneous fractional clearances were determined for both test macromolecules in five Wistar-Furth rats. The results indicate that for a molecular radius of 28.45 A, as measured by gel filtration, the sugar polymer has a fractional clearance of 0.483 on the average, exceeding that of the protein tracer, with a value of 0.068, by a factor less than 7. We conclude that other molecular parameters such as shape, flexibility, and deformability play important roles in the transport of macromolecules across the extracellular matrix that constitutes the glomerular filter.
The use of biotin–avidin binding to facilitate biomodification of thermoresponsive culture surfaces
Authors: Masanori Nishi, Jun Kobayashi, Sebastian Pechmann, Masayuki Yamato, Yoshikatsu Akiyama, Akihiko Kikuchi, Katsumi Uchida, Marcus Textor, Hirofumi Yajima, Teruo Okano
Journal: Biomaterials (2007)
ELEVATORS NEEDED IN PUBLIC SCHOOLS
Authors: Morris H. Kahn
Journal: JAMA (1926)

<h3>To the Editor:</h3> —Concerning the need of elevators in the public schools of New York, I am glad that Dr. Goldberger (The Journal, October 30) does not defend the lack of elevators on medical grounds, but rather as an official of the board of education of New York. I am also glad that Dr. Goldberger does not deny that not one of the 605 elementary schools in Greater New York has an elevator. It is a reflection on the city that the public schools are the only public buildings without elevators, and the majority of these are four and five stories high. In the consensus of medical opinion, stair climbing has a harmful effect on the hearts of children. This opinion is corroborated by numerous letters from the principals in the various schools, from which I can extract the following: The climbing of stairs in buildings of four or five