tbuckley/cabot-search huggingface dataset:
A Case of Pregnancy Complicated by Cardiac Decompensation and Anemia Gravidarum
Authors: SAMUEL R. MEAKER
Journal: Annals of Internal Medicine (1929)

Article1 December 1929A Case of Pregnancy Complicated by Cardiac Decompensation and Anemia GravidarumSAMUEL R. MEAKER, M.D., F.A.C.S., FELICE BONGIORNO, M.D.SAMUEL R. MEAKER, M.D., F.A.C.S.Search for more papers by this author, FELICE BONGIORNO, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-3-6-608 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptDuring the past few years the attention of both obstetricians and internists has been actively engaged by the problem of cardiac disease in pregnant women. Some interest has developed also in that curious type of essential anemia which is occasionally associated with the pregnant state. It seems worth while, therefore, to record a case which presented both of these complications, each in a severe form.REPORT OF CASEMrs. C. B., an Italian housewife of 36, entered the Waltham Hospital on February 1, 1928, early in the eighth month of her fourth pregnancy.The only significant item in her past... GALLUPEO'HARA HQD: Puerperal Anaemia. Boston Medical and Surgical Journal, Vol. 190, No. 5, pp. 161-164, Jan. 31, 1924. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: SAMUEL R. MEAKER, M.D., F.A.C.S.; FELICE BONGIORNO, M.D.Affiliations: Boston, Massachusetts PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTHE PATHOLOGY AND TREATMENT OF ANÆMIA. 1 December 1929Volume 3, Issue 6Page: 608-610KeywordsAnemiaHeart diseasesPregnancy ePublished: 1 December 2008 Issue Published: 1 December 1929 PDF downloadLoading ...
Before Chernobyl: Savannah River-Reply
Authors: Carl J. Johnson
Journal: JAMA (1987)

<h3>In Reply.—</h3> I have accurately cited a Savannah River Plant (SRP) internal health physics report<sup>1</sup>of a clandestine release of 5831 × 10<sup>10</sup>Bq (1576 Ci) of iodine 131 in 1956, about 105 times larger than the 55.5 × 10<sup>10</sup>Bq (15 Ci) alleged by the Nuclear Regulatory Commission to have been released from the Three Mile Island nuclear plant accident.<sup>2,3</sup>(Other reports<sup>3-5</sup>indicate Three Mile Island releases were several orders of magnitude greater.) That formerly secret SRP health physics report sharply contradicts a later SRP publication<sup>6</sup>that reported no<sup>131</sup>I releases in 1956, acknowledging only a release of 0.7826 × 10<sup>10</sup>Bq (0.2115 Ci) of<sup>129</sup>I. Dr Hightower cites estimates of a maximum hypothetical dose to an infant living at the plant perimeter to be about 4.8 mSv (480 mrem) (or 2.6 mSv [260 mrem] by the Food and Drug Administration
Pharmacological prevention of serious anaphylactic reactions due to iodinated contrast media: systematic review
Authors: Martin R Tramèr, Erik von Elm, Pierre Loubeyre, Conrad Hauser
Journal: BMJ (2006)

<h3>Abstract</h3> <b>Objective</b> To review the efficacy of pharmacological prevention of serious reactions to iodinated contrast media. <b>Design</b> Systematic review. <b>Data sources</b> Systematic search (multiple databases, bibliographies, all languages, to October 2005) for randomised comparisons of pretreatment with placebo or no treatment (control) in patients receiving iodinated contrast media. <b>Review methods</b> Trial quality was assessed by all investigators. Information on trial design, population, interventions, and outcomes was abstracted by one investigator and cross checked by the others. Data were combined by using Peto odds ratios with 95% confidence intervals. <b>Results</b> Nine trials (1975-96, 10 011 adults) tested H<sub>1</sub> antihistamines, corticosteroids, and an H<sub>1</sub>-H<sub>2</sub> combination. No trial included exclusively patients with a history of allergic reactions. Many outcomes were not allergy related, and only a few were potentially life threatening. No reports on death, cardiopulmonary resuscitation, irreversible neurological deficit, or prolonged hospital stays were found. In two trials, 3/778 (0.4%) patients who received oral methylprednisolone 2×32 mg or intravenous prednisolone 250 mg had laryngeal oedema compared with 11/769 (1.4%) controls (odds ratio 0.31, 95% confidence interval 0.11 to 0.88). In two trials, 7/3093 (0.2%) patients who received oral methylprednisolone 2×32 mg had a composite outcome (including shock, bronchospasm, and laryngospasm) compared with 20/2178 (0.9%) controls (odds ratio 0.28, 0.13 to 0.60). In one trial, 1/196 (0.5%) patients who received intravenous clemastine 0.03 mg/kg and cimetidine 2-5 mg/kg had angio-oedema compared with 8/194 (4.1%) controls (odds ratio 0.20, 0.05 to 0.76). <b>Conclusions</b> Life threatening anaphylactic reactions due to iodinated contrast media are rare. In unselected patients, the usefulness of premedication is doubtful, as a large number of patients need to receive premedication to prevent one potentially serious reaction. Data supporting the use of premedication in patients with a history of allergic reactions are lacking. Physicians who are dealing with these patients should not rely on the efficacy of premedication.
Heterogeneity of Genetic Modifiers Ensures Normal Cardiac Development
Authors: Julia B. Winston, Jonathan M. Erlich, Courtney A. Green, Ashley Aluko, Kristine A. Kaiser, Mai Takematsu, Robert S. Barlow, Ashish O. Sureka, Martin J. LaPage, Luc L. Janss, Patrick Y. Jay
Journal: Circulation (2010)

Background— Mutations of the transcription factor Nkx2-5 cause pleiotropic heart defects with incomplete penetrance. This variability suggests that additional factors can affect or prevent the mutant phenotype. We assess here the role of genetic modifiers and their interactions. Methods and Results— Heterozygous Nkx2-5 knockout mice in the inbred strain background C57Bl/6 frequently have atrial and ventricular septal defects. The incidences are substantially reduced in the Nkx2-5 +/− progeny of first-generation (F1) outcrosses to the strains FVB/N or A/J. Defects recur in the second generation (F2) of the F1×F1 intercross or backcrosses to the parental strains. Analysis of &gt;3000 Nkx2-5 +/− hearts from 5 F2 crosses demonstrates the profound influence of genetic modifiers on disease presentation. On the basis of their incidences and coincidences, anatomically distinct malformations have shared and unique modifiers. All 3 strains carry susceptibility alleles at different loci for atrial and ventricular septal defects. Relative to the other 2 strains, A/J carries polymorphisms that confer greater susceptibility to atrial septal defect and atrioventricular septal defects and C57Bl/6 to muscular ventricular septal defects. Segregation analyses reveal that ≥2 loci influence membranous ventricular septal defect susceptibility, whereas ≥2 loci and at least 1 epistatic interaction affect muscular ventricular and atrial septal defects. Conclusions— Alleles of modifier genes can either buffer perturbations on cardiac development or direct the manifestation of a defect. In a genetically heterogeneous population, the predominant effect of modifier genes is health.
PSYCHOSIS, DRIVE AND INHIBITION : A THEORETICAL AND EXPERIMENTAL ACCOUNT
Authors: H. J. EYSENCK
Journal: American Journal of Psychiatry (1961)

An attempt has been made in this paper to account in theoretical terms for the generalised slowness which has been shown in previous work to characterise psychotic patients. Making use of the theoretical framework of modern learning theory, two hypotheses were put forward, relating psychotic slowness respectively to: 1. Lack of drive ( motivation) ; 2. An exceedingly slow rate of dissipation of reactive inhibition. It was deduced from the theorems of learning theory that psychotics should be characterised by very low reminiscence scores on tasks involving massed practice if either of the two hypotheses were correct, and experimental evidence does indeed show that psychotics are differentiated from normals and neurotics in precisely this way. It was then argued that a crucial test between the two hypotheses could be performed by varying the length of the rest period used for establishing reminiscence scores, and it was found that while with short rest periods psychotics showed no reminiscence, they did show very strong reminiscence effects after long rest periods. This is interpreted as irreconcilable with the hypothesis of low drive in psychotics, and may be used as support for the hypothesis that psychotics are characterised by a slow rate of dissipation of inhibition.
Biliary complications of cystic fibrosis.
Authors: S O'Brien, M Keogan, M Casey, G Duffy, D McErlean, M X Fitzgerald, J E Hegarty
Journal: Gut (1992)

One hundred and four adult patients with cystic fibrosis were evaluated for the presence of liver disease as defined by abnormal liver function tests of six months' duration, histological evidence of fibrosis or cirrhosis, or the presence of portal hypertension, or both. Twenty patients fulfilled these criteria and were evaluated further for the presence of biliary tract abnormalities with biliary scintigraphy using 99Tc diisopropylphenyl-carboxymethyl iminodiacetic acid (DISIDA) and endoscopic retrograde cholangiography. Clearance of 99Tc DISIDA from the liver and biliary tree was diminished at 45 (E45) and 60 (E60) minutes in the patients with liver disease compared with those without liver disease; E45 = 37.8% and 65.8%, p less than 0.01; E60 = 48.2% and 77.5%, p less than 0.01 respectively. Serial analogue images of the extrahepatic biliary tree were consistent with common bile duct obstruction with retention of DISIDA and tapering of the common bile duct in seven of 18 patients with and two of 10 patients without liver disease. Endoscopic retrograde cholangiography showed changes consistent with sclerosing cholangitis, with beading and stricturing of the intrahepatic ducts in 12 of the 14 patients. In all 14 patients, including those in whom biliary scintigraphy had suggested obstruction, no abnormality of the common bile duct was identified. These results indicate that abnormalities of the bile ducts in patients with cystic fibrosis related liver disease are confined to the intrahepatic biliary tree and that common bile duct strictures do not contribute to either the progression or development of liver disease in these patients.
Legalizing Assisted Suicide — Views of Physicians in Oregon
Authors: Melinda A. Lee, Heidi D. Nelson, Virginia P. Tilden, Linda Ganzini, Terri A. Schmidt, Susan W. Tolle
Journal: New England Journal of Medicine (1996)

Since the Oregon Death with Dignity Act was passed in November 1994, physicians in Oregon have faced the prospect of legalized physician-assisted suicide. We studied the attitudes and current practices of Oregon physicians in relation to assisted suicide.
P63 Assessment Of Regional Variability In Matrix Metalloproteinase Concentrations By Ct Informed Bronchoalveolar Lavage In Patients With Copd
Authors: K. Ostridge, S. Harden, P. Elkington, K. Staples, T. Wilkinson
Journal: Thorax (2014)

<h3>Background</h3> Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes involved in the normal physiological turnover of the pulmonary extracellular matrix. They have been implicated in animal models of emphysema. However, there have been conflicting results in human studies, largely due to the anatomical regional variability and heterogeneity of COPD not being taken into account. This study aims to understand the role of MMPs in COPD by using CT analysis to guide regional bronchoalveolar lavage (BAL) and employing multiplex profiling of this fluid. <h3>Methods</h3> Twelve mild-to-moderate COPD patients (FEV1/FVC ratio &lt;0.7, FEV1 &gt;50%) underwent high resolution spiral chest CT. This was reported by a thoracic radiologist and lobes with most and least evidence of disease (emphysema or bronchial wall thickening) were identified. During bronchoscopy 100 ml of saline was instilled into each of these lobes and the BAL was collected. This fluid was filtered and then concentrated 2-fold by lyophilisation. MMP-1, -2, -3, -7, -8 and -9 were measured using a multiplex ELISA. Sample protein concentration was determined using a Bradford assay. MMP concentration was corrected for BAL protein concentration. <h3>Results</h3> MMPs and protein were successfully detected in BAL. Median values for MMP-1, -2, -3, -7, -8 and -9 were all increased in the diseased lobe compared to the relatively preserved lobe. This was significant for MMP-2 and -3 and trended towards significance for MMP-1 and -7 (Table 1). <h3>Conclusion</h3> These results suggest that certain MMPs are present in greater quantities in areas of the lungs most affected by COPD, adding to the evidence that they may be involved in the pathogenesis of the disease. This study also demonstrates the regional anatomical variability of COPD in respect to imaging abnormalities and the underlying disease processes. Regional sampling needs to be considered in future studies to enable full understanding of the heterogeneous pathological mechanisms involved in COPD.
Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy.
Authors: D Levy, M Salomon, R B D'Agostino, A J Belanger, W B Kannel
Journal: Circulation (1994)

During the past half-century, the ECG has been used extensively for the diagnosis of left ventricular hypertrophy. Persons with ECG evidence of left ventricular hypertrophy are at increased risk for the development of cardiovascular disease.Subjects from the Framingham Heart Study with ECG evidence of left ventricular hypertrophy were eligible for this investigation if they were free of cardiovascular disease and did not have complete bundle-branch block or Wolff-Parkinson-White syndrome. Logistic regression analyses of pooled biennial examinations were used to determine risk for cardiovascular disease as a function of baseline voltage (sum of R wave in aVL plus S wave in V3) and repolarization and as a function of serial changes in these ECG features of hypertrophy. The eligible sample consisted of 274 men (mean age, 60 years) and 250 women (mean age, 64 years) who contributed 2660 person-examinations. During follow-up, there were 269 new cardiovascular events. Compared with subjects in the first quartile of voltage at baseline, the age-adjusted odds ratio for cardiovascular disease among subjects in the fourth quartile was 3.08 (95% confidence interval [CI], 1.87 to 5.07) in men and 3.29 (95% CI, 1.78 to 6.09) in women. Compared with a normal repolarization pattern, the presence of severe repolarization abnormalities was associated with an age-adjusted odds ratio of 5.84 (95% CI, 3.55 to 9.62) in men and 2.47 (95% CI, 1.38 to 4.42) in women. Subjects with a serial decline in voltage were at lower risk for cardiovascular disease than were those with no serial change (men: odds ratio after adjusting for age and baseline voltage, 0.46; 95% CI, 0.26 to 0.84; women: odds ratio, 0.56; 95% CI, 0.30 to 1.04). In contrast, those with a serial increase in voltage were at greater risk for cardiovascular disease (men: odds ratio, 1.86; 95% CI, 1.14 to 3.03; women: odds ratio, 1.61; 95% CI, 0.91 to 2.84). Compared with those with no serial change, an improvement in repolarization was associated with a marginally significant reduction in cardiovascular risk in men (odds ratio after adjusting for age and baseline repolarization, 0.45; 95% CI, 0.20 to 1.01). Worsening of repolarization was associated with increased risk for cardiovascular disease in both sexes (men: odds ratio, 1.89; 95% CI, 1.05 to 3.40; women: odds ratio, 2.02; 95% CI, 1.07 to 3.81).The results of this investigation suggest that regression of ECG features of left ventricular hypertrophy confers an improvement in risk for cardiovascular disease, whereas serial worsening imposes increased risk. The benefits to be derived from regression of left ventricular hypertrophy must be confirmed in other clinical settings.
Evidence Fails to Support ECG Screening for Those Without Heart Disease Symptoms
Authors: Mike Mitka
Journal: JAMA (2011)

PHYSICIANSDOINGROUTINEPHYSICAL examinationsonolder individuals frequently call for a resting or exerciseelectrocardiogram(ECG)todetect heartabnormalities.Althoughscreening ECGsinasymptomaticindividualsdodetectabnormalitiesassociatedwithhigher riskforadversecardiovascularevents,rigorous evidence is lacking to determine whether such tests actuallychangeclinical actions and improve outcomes, said authors of a 2011 review (Chou R et al. Ann Intern Med. 2011;155[6]:375-385). The review, requested by the US PreventiveServicesTaskForce,reaffirmsthe 2004 recommendation by the task force againstscreeningwithrestingorexercise ECG in adults at low risk for coronary heart disease. Roger Chou, MD, lead author of the reviewandanassociateprofessorofmedicineatOregonHealth&ScienceUniversityinPortland,saidhisteam’smainfocus was to understand what added benefit ECG would provide over traditional Framingham risk assessment to physicians evaluating patients. Framingham riskassessment isbasedonascoringsystemthatcalculatesanindividual’s10-year percentage risk of myocardial infarction or coronary death based on age, sex, levels of total and high-density lipoprotein cholesterol, smoking status, and blood pressure readings. Individuals are stratified to 3 risk levels: low ( 10%), intermediate (10%-20%), or high ( 20%). The reviewers looked at 65 Englishlanguage articles published from 2002 through January 2011 and found that none addressed whether ECG screening improved outcomes, affected clinical decision making, or improved Framingham risk reclassification. They included 2 studies looking at direct harms from ECG screening and found the test safe. The 63 studies addressing ECG findings and risk for cardiovascular events showed that abnormalities on resting ECG or exercise ECG were associated with increased risk. “We wanted to understand how the ECG findings would affect clinical
Diagnosis of the acute abdomen.
Authors: H. Ellis
Journal: BMJ (1968)

The patient with acute abdominal pain remains today as the principal purely clinical problem which confronts the medical practitioner.In no other common situation is reliance on clinical features, immediate decision, and accurate diagnosis of such paramount importance.In most other fields an initially tentative, or even incorrect, clinical diagnosis is not necessarily harmful; we can wait until it is confirmed or refuted by laboratory and radiological investigations.But in acute ab- dominal conditions delays of even a few hours in initiating the correct line of treatment may make the difference between a smooth or stormy course-or indeed even place the patient in lethal danger.To leave, for example, an early case of perforated peptic ulcer overnight undiagnosed and well sedated with morphine means missing the opportunity of achieving almost certain recovery for this patient; next morning one will be faced with a desperately ill patient with advanced peritonitis whose chances of survival have been seriously jeopardized.Sir Heneage Olgilvie summed this up perfectly when he wrote that "in the acute abdominal emergencies the difference between the best and the worst surgery is infinitely less than that between early and late surgery, and the greatest sacrifice of all is the sacrifice of time."Acute abdominal pain is not only an important diagnostic problem but it is also often a difficult one.It is vital to remember that the pain may result from disease of almost any organ in the body.Apart from the abdominal and retroperitoneal viscera themselves, including of course the pelvic organs, one must also consider the chest, the central nervous system, and even the ears and throat.Basal pneumonia, acute cardiac ischaemia, and spinal root irritation can all mimic the acute abdomen.Children with otitis media are notorious for complaining of belly-ache.Metabolic disorders, particularly diabetes, but also acute porphyria, may give acute abdominal symptoms.Finally the psychological disturbance of the Munchausen syndrome provides us with a teasing diagnostic difficulty.
THE RELATION OF THE SPLEEN TO BLOOD DESTRUCTION AND REGENERATION AND TO HEMOLYTIC JAUNDICE
Authors: Richard M. Pearce, J. H. Austin
Journal: The Journal of Experimental Medicine (1912)

In a large proportion of dogs that have been splenectomized for periods of two weeks or more, one finds a great increase in the number of endothelial cells of the lymph nodes. In most splenectomized dogs that succumb to an injection of hemolytic immune serum within forty-eight hours, the sinuses of the lymph nodes contain large numbers of endothelial cells, phagocytic for red cells. This is not seen in normal dogs receiving hemolytic serum. Likewise a similar power of phagocytosis is seen frequently in the stellate cells of the capillaries of the liver. Both in the lymph nodes and the liver these cells appear to be formed in situ; we find no evidence that they have been transported to these organs. Such findings suggest the development of a compensatory function on the part of the lymph nodes and possibly of the liver. Normally the spleen contains cells which have the power to engulf and presumably to destroy the red blood corpuscles. In certain pathological conditions this function is frequently greatly augmented and may sometimes be shared by the lymph nodes, for example, in typhoid fever, as was first clearly shown by Mallory. Our observations suggest that in the absence of the spleen, this function of forming red blood corpuscle-phagocyting cells, normally a minor activity of the lymph nodes, becomes highly developed in the latter organs, and that these cells, and the stellate cells of the liver, thus assume, in part at least, the function of destroying red blood corpuscles by phagocytosis. In view of the somewhat limited material at our disposal, we offer this, not as definitely conclusive, but as evidence which, in connection with the work of others, is highly suggestive of the possibility of the lymph nodes assuming some of the function of the spleen. Whether this activity of the endothelial cells of the lymph nodes and the liver has any bearing on the anemia that follows splenectomy and on the occurrence of spontaneous jaundice in the late periods after splenectomy, is not yet clear.
Interaction in the cerebral metabolism of the biogenic amines: effect of intravenous infusion of L-tryptophan on the metabolism of dopamine and 5-hydroxyindoles in brain and cerebrospinal fluid.
Authors: Y N Pande
Journal: BMJ (1972)

intensive help that these families need.Finally, I would question Dr. Hersov's suggestion that the family doctor is in a position to provide the necessary help.Apart from the shortage of time which must surely prevent him from carrying out the necessary interviews with all the family, including
Clinicians and the coronial system: ability of clinicians to recognise reportable deaths.
Authors: R D Start, Y Delargy-Aziz, C P Dorries, P B Silcocks, D W Cotton
Journal: BMJ (1993)

OBJECTIVE--To assess the ability of clinicians to recognise deaths which require referral to the coroner. DESIGN--Postal questionnaire consisting of 16 fictitious case histories, 14 of which contained a clear indication for referral to the coroner. SETTING--Large teaching hospital. Coroner9s office. SUBJECTS--200 clinicians from general medical and surgical firms and senior staff of the local coroner9s office (two coroner9s officers and the two deputy coroners). MAIN OUTCOME MEASURES--Number of correct assessments on questionnaire. RESULTS--The mean recognition score for the clinicians was 9.11 (range 3-14) with no difference between the clinical grades. All of the coroner9s senior staff recorded maximum recognition scores of 16. CONCLUSIONS--The study highlights several features of the coronial system which are poorly understood by clinicians and provides the basis for an initiative to improve the medicolegal education of all clinicians.