tbuckley/cabot-search huggingface dataset:
Book: Excerpts from a Family Medical Dictionary
Authors: John Quin
Journal: BMJ (2004)

How to write about the death of your mother? That is the burden Rebecca Brown admirably shoulders in this short and valuable memoir. Each pithy chapter is titled after a medical term, an ever serious litany that charts the downward spiral of a life.​life.




Figure 1



Rebecca Brown

Granta, £10, pp 108 ISBN 1 86207 642 1

Rating: ★★★★




Brown's mother was an active soul who rarely complained, a keen driver based in New Mexico who travelled across the vast spaces of American desert to visit her beloved family on the West Coast. One time she isn't up to it, she feels tired—“her doctor had told her she needed rest.” When she gets to the right team it turns out that she has metastatic gastric carcinoma: “Your mother is profoundly anemic,” this new doctor said. Then he repeated, “profoundly.”

Neither panegyric nor horror-show freak out, Brown's reportage of the subsequent medical events is never judgmental, the bad news given straight. Here she is after meeting the surgeon: “He said he couldn't be certain until they got the biopsy back, but `the tumor was probably cancerous.' Then I was doing this thing with the words in my head. I said to myself, He didn't say she had cancer, he only said the tumor was probably cancerous and tumors can be taken out, I thought at exactly the same time. I was making all these fine, picky distinctions in my head.”

Brown's eye on her own and others' reactions are unflinching: “When we came in (to the waiting room) everyone stared at her. The sick people looked healthy compared to her. They looked fantastic. I don't know if she knew how she looked. She smiled and some people tried to smile back, but most people looked away.”

This is a dry eyed and balanced account written after the acute pain has subsided only to leave the blunt ache of loss. Brown's is a lean, laconic story where every word is squeezed out like a drip from a burette. Like Hemingway, like Carver, a simple prose style appears facile but is only achieved after much rewriting, much agonising. Brown's lapidary work is in this tradition and is complimentary to the difficult material.

It has been said with regards to bereavement that there is no language but the cry. Brown finds those elusive words. Essential reading for those involved in palliative care, and that's all of us.
Repetitive strain injury patients have vibration loss
Authors: K. Abbasi
Journal: BMJ (1998)

Repetitive strain injury affecting keyboard users may be associated with loss of vibration in nerves supplying the hands, according to researchers from University College London.

Coauthors Jane Greening, a clinical physiotherapist, and Dr Bruce Lynn, a neurophysiologist, say: “Patients with repetitive strain injury have objective signs of minor polyneuropathy, with the median nerve being more severely affected than the ulnar nerve or radial nerve.” ( Int Arch Occup Environ Health 1998;71:29:34).

Using a vibrameter—a Swedish device for measuring vibration thresholds in sensory nerves—the researchers …
Thyrotropin-Releasing Hormone is not Required for Thyrotropin Secretion in the Perinatal Rat
Authors: Theodor Theodoropoulos, Lewis E. Braverman, Apostolos G. Vagenakis
Journal: Journal of Clinical Investigation (1979)

To determine the role of thyrotropin-releasing hormone (TRH) in the regulation of thyroid-stimulating hormone (TSH) secretion in the perinatal period, a physiological approach of neutralizing circulating TRH in the fetal and early neonatal rat was employed. TRH-antiserum (TRH-AS) raised in rabbits and administered daily to low iodine-propylthiouracil (LID-PTU)-fed pregnant rats from days 12 to 19 of gestation markedly impaired the rise in serum TSH to LID-PTU when compared with normal rabbit serum-treated controls. In contrast, fetal serum TSH was unaffected by TRH-AS. The binding capacity of TRH-AS in the fetal serum (111 ng/ml) far exceeded circulating TRH in the fetus. Similarly, acute TRH-AS administration to the pregnant rat fed LID-PTU markedly decreased the serum TSH concentration in the mother, but not in the fetus, 60 min after TRH-AS administration. Chronic TRH-AS administration to neonatal rats whose nursing mothers were fed LID-PTU was in-effective in decreasing the elevated serum TSH in the neonate through day 8 of life, whereas a slight but significant decrease in serum TSH was observed on day 10. Chronic daily TRH-AS administration to neonatal rats through day 10 of life had no effect on the later development of the hypothalamic-pituitary-thyroid axis. These findings suggest that TRH does not participate in TSH regulation during the perinatal life in the rat and that thyroid hormones are probably the main regulators of TSH secretion during this period. Placental TRH is not important in regulating TSH secretion in the fetal rat. Furthermore, TRH "deprivation" during neonatal life does not prevent normal later development of the hypothalamic-pituitary-thyroid axis.
Reply from Authors re: Urs E. Studer, Laurence Collette, Richard Sylvester. Can Radical Prostatectomy Benefit Patients Despite the Presence of Regional Metastases? Eur Urol 2010;57:762-3
Authors: Jutta Engel, Patrick J. Bastian, Juergen E. Gschwend, Christian G. Stief, Dieter Hölzel
Journal: European Urology (2010)
The Q-T Interval in Rheumatic Fever
Authors: ERNEST CRAIGE, MARIANO M. ALIMURUNG, EDWARD F. BLAND, BENEDICT F. MASSELL
Journal: Circulation (1950)

In 143 rheumatic children the Q-T interval was found to be normal in those with quiescent rheumatic heart disease. In 29 with fatal pancarditis the average Q-T was above the average normal, though not beyond the upper limit of normal. Although parallel changes in the Q-T interval and the clinical manifestations of rheumatic fever occurred in about 66 to 75 per cent of cases, there were significant number of instances where changes in the Q-T and in the clinical course of the disease were in opposite directions.
Mitral Valve Prolapse With Mid-Late Systolic Mitral Regurgitation
Authors: Yan Topilsky, Hector Michelena, Valentina Bichara, Joseph Maalouf, Douglas W. Mahoney, Maurice Enriquez-Sarano
Journal: Circulation (2012)

Background— Mitral regurgitation (MR) of mitral valve prolapse predominates in late systole but may be holosystolic or purely mid-late systolic, but the impact of MR timing on MR left ventricular and left atrial consequences and outcome is unknown. Whether effective regurgitant orifice (ERO) by the flow convergence method is similarly linked to outcome in mid-late systolic MR and holosystolic MR is uncertain. Methods and Results— We comprehensively and prospectively quantified MR in 111 patients with mitral valve prolapse and mid-late systolic MR and matched them to 90 patients with mitral valve prolapse and holosystolic MR for age, gender, atrial fibrillation, ejection fraction, and ERO (flow convergence). Mid-late systolic MR versus holosystolic MR groups were well matched, including for comorbidity, blood pressure, and heart rate (all P &gt;0.10). Mid-late systolic MR versus holosystolic MR caused similar color jet area, midsystolic regurgitant flow, and peak velocity ( P &gt;0.40). Despite identical ERO (0.25±0.15 versus 0.25±0.15 cm 2 ; P =0.53), the shorter duration of mid-late systolic MR (233±56 versus 426±50 ms; P &lt;0.0001) yielded lower regurgitant volume (24.8±13.4 versus 48.6±25.6 mL; P &lt;0.0001). MR consequences, systolic pulmonary pressure, and left ventricular and left atrial volume index (all P &lt;0.001) were more benign in mid-late systolic MR versus holosystolic MR. Under medical management, fewer cardiac events (5 years: 15.8±4.6% versus 40.4±6.1%; P &lt;0.0001) occurred in mid-late systolic MR versus holosystolic MR, requiring less mitral surgery. Multivariable analysis confirmed the independent association of mid-late systolic MR with benign consequences and outcomes (all P &lt;0.01). Absolute ERO was not linked to outcome, in contrast to regurgitant volume. Conclusions— MR of mitral valve prolapse that is purely mid-late systolic causes more benign consequences and outcomes than holosystolic MR. Assessment may be misleading because jet area and ERO by flow convergence appear similar to those of holosystolic MR. However, shorter MR yields lower regurgitant volume, consequences, and benign outcomes. Instantaneous ERO by flow convergence should be interpreted in context, and in mid-late systolic MR, regurgitant volume provides information more reflective of MR severity. Therefore, for clinical management and surgical referral, clinicians should carefully take into account the timing and consequences of MR.
Restenosis after Arterial Injury Caused by Coronary Stenting in Patients with Diabetes Mellitus
Authors: Joseph P. Carrozza
Journal: Annals of Internal Medicine (1993)

Objective: To determine whether diabetic patients, when compared with nondiabetic patients, have a higher incidence of restenosis after coronary stenting, and, if so, whether restenosis is attributable to lesion or procedural differences or to a greater biologic tendency for late loss of minimum diameter in diabetic patients. Design: Case series. Setting: Tertiary care referral center. Patients: Two hundred twenty consecutive patients with coronary artery disease who were referred for placement of a Palmaz-Schatz stent in either a native coronary artery or a saphenous vein graft. Results: Based on a traditional dichotomous definition of restenosis (≥ 50% stenosis at follow-up), lesions in diabetic patients had a significantly greater restenosis rate (55%) than lesions in nondiabetic patients (20%; P = 0.001). Vessel size, lesion length, pre-procedure lesion severity, procedural outcome, and acute gain (the difference between minimum lumen diameter before and after the procedure) were similar in the diabetic and nondiabetic groups. However, at follow-up, stents in diabetic patients had a smaller lumen diameter (1.66 ± 1.18 mm) compared with those in nondiabetic patients (2.24 ± 0.93 mm; P = 0.004), as well as a greater percent stenosis (49% compared with 32%; P = 0.002). Thus, the increased restenosis rate in stents in diabetic patients (55% compared with 20%; P = 0.001) is secondary to increased late loss of minimum lumen diameter (1.66 ± 1.28 mm compared with 1.23 ± 0.97 mm; P = 0.04). Conclusions: After arterial injury produced by stent placement, diabetic patients have a significantly greater incidence of restenosis because of greater late loss at the treatment site. Because elastic recoil or vasospasm contributes little to stent restenosis, the increased late loss of minimum lumen diameter in diabetic patients suggests that they have a greater predisposition to intimal hyperplasia.
Acute Adrenal Insufficiency
Authors: Harold Elrick
Journal: New England Journal of Medicine (1950)

ADDISONIAN crisis is a major medical emergency, like diabetic acidosis, which requires the constant supervision of the physician for a period of days. During the past ten years knowledge of the physiologic basis of adrenal insufficiency has increased; concomitantly, potent specific hormone preparations have become available. It is important for the clinician to be able to use this knowledge and these preparations with maximum efficiency. Delayed, inadequate or too enthusiastic therapy may result in a death that could have been avoided by prompt, intelligent use of the available tools of treatment.There is a need for a definite plan of . . .
A novel murine model to deplete hepatic stellate cells uncovers their role in amplifying liver damage in mice
Authors: Juan E. Puche, Youngmin A. Lee, Jingjing Jiao, Costica Aloman, Maria I. Fiel, Ursula Muñoz, Thomas Kraus, Tingfang Lee, Hal F. Yee, Scott L. Friedman
Journal: Hepatology (2012)

Abstract We have developed a novel model for depleting mouse hepatic stellate cells (HSCs) that has allowed us to clarify their contributions to hepatic injury and fibrosis. Transgenic (Tg) mice expressing the herpes simplex virus thymidine kinase gene ( HSV-Tk ) driven by the mouse GFAP promoter were used to render proliferating HSCs susceptible to killing in response to ganciclovir (GCV). Effects of GCV were explored in primary HSCs and in vivo . Panlobular damage was provoked to maximize HSC depletion by combining CCl 4 (centrilobular injury) with allyl alcohol (AA) (periportal injury), as well as in a bile duct ligation (BDL) model. Cell depletion in situ was quantified using dual immunofluorescence (IF) for desmin and GFAP. In primary HSCs isolated from both untreated wild-type (WT) and Tg mice, GCV induced cell death in ˜50% of HSCs from Tg, but not WT, mice. In TG mice treated with CCl 4 +AA+GCV, there was a significant decrease in GFAP and desmin-positive cells, compared to WT mice (˜65% reduction; P &lt; 0.01), which was accompanied by a decrease in the expression of HSC-activation markers (alpha smooth muscle actin, beta platelet-derived growth factor receptor, and collagen I). Similar results were observed after BDL. Associated with HSC depletion in both fibrosis models, there was marked attenuation of fibrosis and liver injury, as indicated by Sirius Red/Fast Green, hematoxylin and eosin quantification, and serum alanine/aspartate aminotransferase. Hepatic expression of interleukin-10 and interferon-gamma was increased after HSC depletion. No toxicity of GCV in either WT or Tg mice accounted for the differences in injury. Conclusion : Activated HSCs significantly amplify the response to liver injury, further expanding this cell type's repertoire in orchestrating hepatic injury and repair. (Hepatology 2013)
Identification of subpopulations of lymphocytes and macrophages in the infiltrate of lichen planus lesions of skin and oral mucosa
Authors: D.M. WALKER
Journal: British Journal of Dermatology (1976)

The mononuclear cells of the infiltrate in lichen planus lesions of skin and oral mucosa have been identified by detection of their membrane receptors in frozen-tissue sections. By this method, the infiltrate would appear to consist of predominantly T lymphocytes, some macrophages and only a few B cells. The pathogenesis of lichen planus is discussed in the light of these findings.
262 Clinical presentation and outcome of hepatocellular carcinoma in HIV infected patients
Authors: M. Puoti, R. Bruno, V. Soriano, E. Vaccher, F. Donato, G.B. Gaeta, G.P. Quinzan, D. Precone, C. Filice, F. Suter, G. Carosi, U. Tirelli
Journal: Journal of Hepatology (2004)
The IASLC Lung Cancer Staging Project: Proposals for the Inclusion of Broncho-Pulmonary Carcinoid Tumors in the Forthcoming (Seventh) Edition of the TNM Classification for Lung Cancer
Authors: William D. Travis, Dorothy J. Giroux, Kari Chansky, John Crowley, Hisao Asamura, Elisabeth Brambilla, James Jett, Catherine Kennedy, Ramon Rami-Porta, Valerie W. Rusch, Peter Goldstraw
Journal: Journal of Thoracic Oncology (2008)
Autoimmune neutropenia following peripheral blood stem cell transplantation
Authors: Thomas R. Klumpp, Jay H. Herman, John S. Macdonald, Maryann K. Schnell, Mark Mullaney, Kenneth F. Mangan
Journal: American Journal of Hematology (1992)

Abstract The differential diagnosis of unexpected neutropenia following bone marrow transplantation includes several potentially life‐threatening complications including graft rejection, overwhelming infection, relapse of the underlying neoplasm, and intrinsic graft failure. However, a number of recent reports document that the differential diagnosis also includes autoimmune neutropenia, which, although potentially life‐threatening, often responds well to corticosteroids or splenectomy. Autoimmune neutropenia has been reported following both autologous and allogeneic bone marrow transplantation. Herein we report a 31‐year‐old woman who developed a rapidly falling neutrophil count 11 days following peripheral blood stem cell transplantation for non‐Hodgkin's lymphoma. A laboratory evaluation supported a diagnosis of autoimmune neutropenia, and the neutropenia resolved following treatment with steroids and granulocyte‐colony stimulating factor. © 1992 Wiley‐Liss, Inc.
Abnormality in urinary protein excretion in Japanese men with impaired glucose tolerance.
Authors: H Fujita, T Narita, S Ito
Journal: Diabetes Care (1999)

OBJECTIVE: To examine whether subjects with impaired glucose tolerance (IGT) for more than 2 years have any abnormality in the kidney. RESEARCH DESIGN AND METHODS: We measured urinary excretion rate and clearance of various plasma proteins with different molecular radii and different isoelectric points in 22 Japanese men with IGT (IGT group) and 37 age-matched healthy control subjects (control group). RESULTS: Clearance of ceruloplasmin (molecular radius approximately 45 A; isoelectric point 4.4), IgG4 (molecular radius 55 A; isoelectric point 5.4), and IgG (molecular radius 55 A; isoelectric point 7.4) was significantly higher in the IGT group than in the control group, whereas there were no significant differences in urinary excretion rate of albumin (molecular radius 36 A; isoelectric points 4.8-5.2) and clearance of alpha 2-macroglobulin (molecular radius 88 A; isoelectric point 5.4) between the two groups. CONCLUSIONS: In the present study, we found that clearance of neutral-charged IgG, negatively charged IgG4, and ceruloplasmin with molecular radii of approximately 45-55 A was selectively increased in IGT subjects. This finding does not seem to be explained by impairment of charge and pore-size selectivity in the glomerulus. Therefore, considering the present result together with our recent finding that enhanced glomerular filtration rate (GFR) after acute protein loading in healthy subjects induced a selective increase in clearance of IgG, IgG4, and ceruloplasmin, we suggest that increased intraglomerular hydraulic pressure, although enhanced GFR was not demonstrated, may be at work in these mildly hyperglycemic subjects.
Maternal deaths in England and Wales, 1976-8
Authors: D H Vaughan
Journal: BMJ (1983)

The number of gastric ulcers in patients with rheumatic diseases who were taking steroid or non-steroidal anti-inflammatory drugs was not significantly different in men and women, and in any case it was too small for any variation in the male to female ratio to be determined.For duodenal ulcers the male to female ratio was 3:1.In this case too, although less obviously, there was a slight tendency towards a reduction in the percentage of men (r=0-28).In conclusion, the data from our case histories do not confirm Dr Lee's observations, and they confirm a higher male prevalence in the incidence of gastric and duodenal ulcers.We emphasise the tendency towards a reduction in this prevalence, however, although it was not significant, since it accords with the findings of Crown et all before the introduction of H2 blockers, and with Ela- shoff's and Grossman's subsequent findings.2Even if our study and that of Dr Lee are not large enough to justify significant epidemiological conclusions, we can hypothesise that widely differing geographical distributions and environmental and socioeconomic conditions in the two populations may explain the difference in the two studies.
What is a normal upper gastrointestinal tract?
Authors: A P Walker, B F Walker, I Segal
Journal: BMJ (1991)

<h3>Objectives</h3> Person-organisation fit (P-O fit) is a predictor of work attitude. However, in the area of human resource for health, the literature of P-O fit is quite limited. It is unclear whether P-O fit directly or indirectly affects turnover intention. This study aims to examine the mediation effect of job satisfaction on the relationship between P-O fit and turnover intention based on data from China. <h3>Design and methods</h3> This is a cross-sectional survey of community health workers (CHWs) in China in 2013. A questionnaire of P-O fit, job satisfaction and turnover intention was developed, and its validity and reliability were assessed. Multiple regression and structural equation modelling were used to examine the relationship among P-O fit, job satisfaction and turnover intention. <h3>Setting and participants</h3> Multistage sampling was applied. In total, 656 valid questionnaire responses were collected from CHWs in four provincial regions in China, namely Shanghai, Shaanxi, Shandong and Anhui. <h3>Results</h3> P-O fit was directly related to job satisfaction (standardised β 0.246) and inversely related to turnover intention (standardised β −0.186). In the mediation model, the total effect of P-O fit on turnover intention was −0.186 (p&lt;0.001); the direct effect of P-O fit on turnover intention was −0.094 (p&lt;0.01); the indirect effect of job satisfaction on the relationship between P-O fit and turnover intention was −0.092 (p&lt;0.001). <h3>Conclusions</h3> The effect of P-O fit on turnover intention was partially mediated through job satisfaction. It is suggested that more work attitude variables and different dimensions of P-O fit be taken into account to examine the complete mechanism of person-organisation interaction. Indirect measures of P-O fit should be encouraged in practice to enhance work attitudes of health workers.
Shigella Bacteremia in Adults
Authors: William Mandell
Journal: JAMA (1986)

<h3>To the Editor.—</h3> <i>Shigella flexneri</i>is a common cause of intestinal infections in homosexual men.<sup>1</sup>It often presents as a febrile illness associated with abdominal cramps and bloody diarrhea. Bacteremia that is infrequent most often complicates shigellosis in patients younger than 2 years and is considered rare in the adult population.<sup>2,3</sup>We report two cases of bacteremia with<i>S flexneri:</i>one in a patient with acquired immunodeficiency syndrome (AIDS) and the other in a homosexual man with severe hepatitis B. <h3>Report of Cases.—</h3> Case1.—A 25-year-old homosexual man with a history of glucose-6-phosphate dehydrogenase and asymptomatic sickle cell hemoglobin diseases and AIDS was admitted to the hospital with fever, abdominal cramps, and copious nonbloody diarrhea. Physical examination revealed a temperature of 39.5 °C (103.2 °F) orally, and diffuse abdominal tenderness. Laboratory findings included a white blood cell count of 8,300/cu mm with 35% neutrophils, 34% band forms, and
Unsedated Esophagoscopy for the Diagnosis of Esophageal Varices in Patients with Cirrhosis
Authors: P. Darwin, J. Zangara, T. Heller, O. Haluszka, J. Laurin
Journal: Endoscopy (2000)

Unsedated endoscopy with ultrathin endoscopes has been shown to be an alternative to conventional endoscopy. This technique would appear to be an ideal way to screen for varices, but there is scant data for unsedated endoscopy in patients with cirrhosis. The aims of this pilot study were to evaluate whether unsedated endoscopy can be used to screen for varices and to determine how well it is tolerated in patients with hepatic dysfunction.We prospectively evaluated unsedated esophagoscopy in 15 patients with cirrhosis who were candidates for beta-adrenergic-antagonist therapy. Patients with cirrhosis without gastrointestinal bleeding or contraindications to beta-adrenergic-antagonist therapy gave consent to the procedure. The presence and size of varices and the procedure time were recorded. After the procedure, patient tolerance, as gauged by questionnaire and willingness to repeat, was assessed.All patients tolerated the procedure without significant discomfort. The mean time of the procedure was 2 minutes. Esophageal varices were found in nine of 15 patients. Of these, one patient with Child-Pugh class C cirrhosis had large varices and was started on propranolol.Unsedated esophagoscopy in patients with cirrhosis appears to be well tolerated. Given both potential safety and cost benefits over conventional endoscopy, this could be a useful method for screening for varices. A randomized trial comparing this method with standard endoscopy is warranted.
SERUM NEURON-SPECIFIC ENOLASE: A MARKER FOR DISEASE EXTENT AND RESPONSE TO THERAPY OF SMALL-CELL LUNG CANCER
Authors: DesmondN Carney, DanielC Ihde, MartinH Cohen, PaulJ Marangos, PaulA Bunn, JohnD Minna, AdiF Gazdar
Journal: The Lancet (1982)