tbuckley/cabot-search huggingface dataset:
Gastroenteritis in Britain: management at home.
Authors: B A Wharton
Journal: BMJ (1981)

Gastroenteritis in Britain: management at homeGastroenteritis in children is less of a problem in Britain than it was a decade ago, but there is still plenty of room for improvement.As the decade opened deaths during infancy in England and Wales due to "enteritis and other diarrhoeal disease" were 40 per 100 000.There was little change until 1974, since when the rate has fallen substantially to 23 in 1978 and 9 in 1979.1 In 1971 the number of young children (0-4 years) admitted to hospitals in England and Wales for the treatment of gastroenteritis was 855 per 100 000.By 1977 this figure had been halved2-the 1980 triennial analysis of children's admissions is awaited with interest.At least part of this improvement has been attributed3 to the substantial changes in infant feeding practice that followed the Oppe report,4 more breast feeding and the almost universal use of a low-solute formula for bottle-fed babies.Nevertheless, just as in 1972,5 gastroenteritis is still an important killer in the postneonatal period (1-11 months), and the mortality figures in Britain compare unfavourably with those of many of our Common Market partners-the encouragingly low 1973 infant mortality due to gastroenteritis of nine in England and Wales was reached by Holland and Denmark by 1976, while their more recent figures are not available.'In Sheffield gastro- enteritis was responsible for five out of 18 "possibly avoidable" deaths in children aged 1 month to 2 years who were admitted to hospital.6How disturbing, then, to find that few of the children admitted to All Saints Hospital, Chatham, had received appropriate treatment at home (see the article by Morrison and Little at p 1300).Perhaps if they had, fewer would have
The Jejunal Mucosa in Patients with Nutritional Folate Deficiency and Megaloblastic Anemia
Authors: Sidney J. Winawer, Louis W. Sullivan, Victor Herbert, Norman Zamcheck
Journal: New England Journal of Medicine (1965)

ALTHOUGH folic acid administration to patients with tropical sprue improves the clinical state and reverses the megaloblastic anemia its effects on the abnormality of the jejunal mucosa are less clear.1 Alterations induced by folic acid antagonists in the jejunal mucosa in man2 , 3 and in animals4 are the result of acute total folate deprivation and therefore are not strictly comparable to those induced by nutritional folate deficiency.The purpose of the present study was to ascertain whether nutritional folate deficiency of sufficient degree to cause megaloblastic changes in the hematopoietic tissues would be associated with significant changes in the jejunal mucosa. . . .
Prognostic Significance of Simultaneous Measurement of Three Tumor Markers in Patients With Hepatocellular Carcinoma
Authors: Hidenori Toyoda, Takashi Kumada, Seiki Kiriyama, Yasuhiro Sone, Makoto Tanikawa, Yasuhiro Hisanaga, Akihiro Yamaguchi, Masatoshi Isogai, Yuji Kaneoka, Junji Washizu
Journal: Clinical Gastroenterology and Hepatology (2006)

We conducted a prospective study to evaluate the significance of simultaneous measurement of 3 currently used tumor markers in the evaluation of tumor progression and prognosis of patients with hepatocellular carcinoma (HCC).Three tumor markers for HCC, alpha-fetoprotein (AFP), Lens culinaris agglutinin A-reactive fraction of AFP (AFP-L3), and des-gamma-carboxy prothrombin (DCP), were measured in the same serum samples obtained from 685 patients at the time of initial diagnosis of HCC. Positivity for AFP >20 ng/dL, AFP-L3 >10% of total AFP, and/or DCP >40 mAU/mL was determined. In addition, tumor markers were measured after treatment of HCC.Of the 685 patients, 337 (55.8%) were positive for AFP, 206 (34.1%) were positive for AFP-L3, and 371 (54.2%) were positive for DCP. In a comparison of patients positive for only 1 tumor marker, patients positive for AFP-L3 alone had a greater number of tumors, whereas patients positive for DCP alone had larger tumors and a higher prevalence of portal vein invasion. When patients were compared according to the number of tumor markers present, the number of markers present clearly reflected the extent of HCC and patient outcomes. The number of markers present significantly decreased after treatment.Tumor markers AFP-L3 and DCP appear to represent different features of tumor progression in patients with HCC. The number of tumor markers present could be useful for the evaluation of tumor progression, prediction of patient outcome, and treatment efficacy.
State Plans for Surrogate Decision Making-Reply
Authors: Barbara L. Hopkins
Journal: JAMA (1994)

<h3>In Reply.</h3> —In our federal system, states remain the laboratories for innovation. Dr Eckoff's account of Iowa's program for patients with disabilities, enacted 4 years after the New York law we described, affirms our conclusions: the New York approach is readily transferable to other states and it can and should be available to persons in mental disability facilities, to incapacitated nursing home residents, and to others in need of surrogate decision makers. Our concern is with Eckoff's view that a guardian need eventually be appointed if the patient requires substituted decision making over a period of time. The New York law has several features that allow a more flexible response to this type of situation. First, the New York State Surrogate Decision-Making Committee panels can be convened quickly (usually within 14 days),<sup>1</sup>and they are required to make their decisions on the day of the hearing where practicable.<sup>2</sup>
Aeroallergen patch testing for patients presenting to contact dermatitis clinics
Authors: S.Elizabeth Whitmore, Elizabeth F Sherertz, Donald V Belsito, Howard I Maibach, James R Nethercott
Journal: Journal of the American Academy of Dermatology (1996)

The role of aeroallergens in the production of allergic contact dermatitis or "allergic contact dermatitis-like" atopic dermatitis is controversial. Although techniques and allergens lack standardization, most studies find positive patch test results in 30% to 40% of patients with atopic dermatitis.Our purpose was to determine the prevalence and clinical significance of positive aeroallergen patch tests in patients undergoing standard patch testing for suspected "nonaeroallerge" allergic contact dermatitis.One hundred three consecutive patients referred to three university patch test clinics for patch testing were alos patch tested with six common aeroallergens in glycerine-dust, mold, cat epithelium, tree, grass, and weed-as well as with a glycerine control. Patches were removed at 48 hours. Readings were performed at this time and at 3 to 7 days after initial application.As determined by history, these 103 patients included 16 patients with both atopic dermatitis and mucosal atopy, 10 patients with atopic dermatitis only, 22 patients with mucosal atopy only, and 55 patients with neither atopic dermatitis nor mucosal atopy. Allergic reactions were seen to one aeroallergen in five patients (three with atopic dermatitis and mucosal allergy, and two with no history of atopy). The prevalence (3 of 16 [18.8%]) of reactions in patients with both atopic dermatitis and mucosal allergy was significantly greater than the prevalence (2 of 87 [2.3%]) in patients with only one or neither of these two atopic disorders (p = 0.02). None of these aeroallergen contact hypersensitivities were deemed significant in the patients' current dermatitis. However, reactions were of past relevance in two of the three patients with atopic dermatitis and mucosal allergy.In this referral group, none of the six common aeroallergens tested was relevant in the origin of suspected "nonaeroallergen" allergic contact dermatitis. This study suggests that aeroallergen patch testing is of little use in the evaluation of patients referred for routine patch testing for suspected "nonaeroallergen" allergic contact dermatitis. Similar but larger studies inclusive of the assessment of relevance, as well as masked controlled clinical trials assessing the effect of aeroallergen exposure and avoidance, are needed to evaluate this issue more fully.
Hospital consultants are to get 3% pay rise
Authors: L. Eaton
Journal: BMJ (2003)

The Doctors and Dentists Review Body has recommended that hospital consultants in England and Wales—who last year rejected a new three year pay deal worth 19%—be given a salary increase of 3.2%.

The recommendations, announced on 19 May and accepted by the government, met with disappointment from the BMA.

Dr Ian Bogle, the association's chairman, said …
Bone Imaging: Radionuclide Scan vs MRI
Authors: M. Moinuddin
Journal: JAMA (1990)

<h3>To the Editor.—</h3> With reference to the article "Musculoskeletal Applications of Magnetic Resonance Imaging [MRI],"<sup>1</sup>we offer the following comments. Page 2423 shows a metastatic lesion in the sacrum on MRI examination with a negative bone scan. However, the bone scan in the figure is an anterior view, which will not show a posterior lesion. That is why anterior and posterior views are performed routinely in bone scintigraphy. Similarly, on page 2425, a negative posterior view of the bone scan is presented, with a positive MRI scan showing a stress fracture of the right femoral neck. Bone scans show hip fractures almost exclusively on the anterior view; again, a wrong view was depicted. Although the article was published by the Council on Scientific Affairs, we were impressed by the lack of knowledge about bone scintigraphy. Indeed, MRI is an excellent imaging modality, but that does not mean the authors
Acute effects of dobutamine on myocardial oxygen consumption and cardiac efficiency measured using carbon-11 acetate kinetics in patients with dilated cardiomyopathy
Authors: Rob S.B. Beanlands, David S. Bach, Raymond Raylman, William F. Armstrong, Vance Wilson, Mary Montieth, Charles K. Moore, Eric Bates, Markus Schwaiger
Journal: Journal of the American College of Cardiology (1993)
CT-guided pleural biopsy preferable to traditional Abram's needle in diagnosing malignant pleural disease
Authors: P Bhatia
Journal: Thorax (2003)

▴ Maskell NA, Gleeson FV, Davies RJO. Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: a randomised controlled trial. Lancet2003;361:1326–30 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Malignant disease is a leading cause of pleural effusion, with about 40 000 cases occurring annually in the UK and 175 000 in the USA. Pleural fluid cytology establishes a diagnosis in only 60% of these effusions. Pleural biopsy using an Abram’s needle, … [1]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DMaskell%26rft.auinit1%253DN.%2BA.%26rft.volume%253D361%26rft.issue%253D9366%26rft.spage%253D1326%26rft.epage%253D1330%26rft.atitle%253DStandard%2Bpleural%2Bbiopsy%2Bversus%2BCT-guided%2Bcutting-needle%2Bbiopsy%2Bfor%2Bdiagnosis%2Bof%2Bmalignant%2Bdisease%2Bin%2Bpleural%2Beffusions%253A%2Ba%2Brandomised%2Bcontrolled%2Btrial.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252803%252913079-6%26rft_id%253Dinfo%253Apmid%252F12711467%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0140-6736(03)13079-6&link_type=DOI [3]: /lookup/external-ref?access_num=12711467&link_type=MED&atom=%2Fthoraxjnl%2F58%2F7%2F588.atom [4]: /lookup/external-ref?access_num=000182346100009&link_type=ISI
Higher vs Lower Positive End-Expiratory Pressure in Patients With Acute Lung Injury and Acute Respiratory Distress Syndrome
Authors: Matthias Briel, Maureen Meade, Alain Mercat, Roy G. Brower, Daniel Talmor, Stephen D. Walter, Arthur S. Slutsky, Eleanor Pullenayegum, Qi Zhou, Deborah Cook, Laurent Brochard, Jean-Christophe M. Richard, Francois Lamontagne, Neera Bhatnagar, Thomas E. Stewart, Gordon Guyatt
Journal: JAMA (2010)

Trials comparing higher vs lower levels of positive end-expiratory pressure (PEEP) in adults with acute lung injury or acute respiratory distress syndrome (ARDS) have been underpowered to detect small but potentially important effects on mortality or to explore subgroup differences.To evaluate the association of higher vs lower PEEP with patient-important outcomes in adults with acute lung injury or ARDS who are receiving ventilation with low tidal volumes and to investigate whether these associations differ across prespecified subgroups.Search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (1996-January 2010) plus a hand search of conference proceedings (2004-January 2010).Two reviewers independently screened articles to identify studies randomly assigning adults with acute lung injury or ARDS to treatment with higher vs lower PEEP (with low tidal volume ventilation) and also reporting mortality.Data from 2299 individual patients in 3 trials were analyzed using uniform outcome definitions. Prespecified effect modifiers were tested using multivariable hierarchical regression, adjusting for important prognostic factors and clustering effects.There were 374 hospital deaths in 1136 patients (32.9%) assigned to treatment with higher PEEP and 409 hospital deaths in 1163 patients (35.2%) assigned to lower PEEP (adjusted relative risk [RR], 0.94; 95% confidence interval [CI], 0.86-1.04; P = .25). Treatment effects varied with the presence or absence of ARDS, defined by a value of 200 mm Hg or less for the ratio of partial pressure of oxygen to fraction of inspired oxygen concentration (P = .02 for interaction). In patients with ARDS (n = 1892), there were 324 hospital deaths (34.1%) in the higher PEEP group and 368 (39.1%) in the lower PEEP group (adjusted RR, 0.90; 95% CI, 0.81-1.00; P = .049); in patients without ARDS (n = 404), there were 50 hospital deaths (27.2%) in the higher PEEP group and 44 (19.4%) in the lower PEEP group (adjusted RR, 1.37; 95% CI, 0.98-1.92; P = .07). Rates of pneumothorax and vasopressor use were similar.Treatment with higher vs lower levels of PEEP was not associated with improved hospital survival. However, higher levels were associated with improved survival among the subgroup of patients with ARDS.
Soft Tissue Sarcoma Cells Are Highly Sensitive to AKT Blockade: A Role for p53-Independent Up-regulation of GADD45α
Authors: Quan-Sheng Zhu, Wenhong Ren, Borys Korchin, Guy Lahat, Adam Dicker, Yiling Lu, Gordon Mills, Raphael E. Pollock, Dina Lev
Journal: Cancer Research (2008)

Abstract The AKT signaling pathway is activated in soft tissue sarcoma (STS). However, AKT blockade has not yet been studied as a potential targeted therapeutic approach. Here, we examined the in vitro and in vivo effects of AKT inhibition in STS cells. Western blot analysis was used to evaluate the expression of AKT pathway components and the effect of AKT stimulation and inhibition on their phosphorylation. Cell culture assays were used to assess the effect of AKT blockade (using a phosphatidylinositol 3-kinase inhibitor and a specific AKT inhibitor) on STS cell growth, cell cycle, and apoptosis. Oligoarrays were used to determine gene expression changes in response to AKT inhibition. Reverse transcription–PCR was used for array validation. Specific small inhibitory RNA was used to knockdown GADD45α. Human STS xenografts in nude mice were used for in vivo studies, and immunohistochemistry was used to assess the effect of treatment on GADD45α expression, proliferation, and apoptosis. Multiple STS cell lines expressed activated AKT. AKT inhibition decreased STS downstream target phosphorylation and growth in vitro; G2 cell cycle arrest and apoptosis were also observed. AKT inhibition induced GADD45α mRNA and protein expression in all STS cells treated independent of p53 mutational status. GADD45α knockdown attenuated the G2 arrest induced by AKT inhibition. In vivo, AKT inhibition led to decreased STS xenograft growth. AKT plays a critical role in survival and proliferation of STS cells. Modulation of AKT kinase activity may provide a novel molecularly based strategy for STS-targeted therapies. [Cancer Res 2008;68(8):2895–903]
Ventricular Conduction Blocks and Sudden Death in Acute Myocardial Infarction
Authors: James M. Atkins, Stephen J. Leshin, Gunnar Blomqvist, Charles B. Mullins
Journal: New England Journal of Medicine (1973)

Abstract Of 425 patients with acute myocardial infarction admitted to a coronary-care unit 77 (18 per cent) had ventricular conduction blocks. Complete heart block developed in 43 per cent with right-bundle-branch block and left-axis deviation, in 17 per cent with left-bundle-branch block, and in 6 per cent without ventricular conduction blocks. In-hospital mortality was 30 per cent in patients with and 14 per cent without ventricular conduction block. Late sudden death occurred in five of six patients with right-bundle-branch block and left-axis deviation who had transient complete heart blocks during myocardial infarction, whereas eight similar patients with complete heart block with permanent pacing were alive. These findings suggest that patients with this form of block with an acute myocardial infarction should have temporary standby pacemakers inserted. If complete heart block develops in such cases in association with an acute myocardial infarction, even though transient, permanent pacing should be...
Papa, Nicole, and the guideline industry
Authors: P. Hodgkin
Journal: BMJ (1998)

In the television advertisement for Renault neither the suave Papa nor his sophisticated daughter, Nicole, are thinking much about cars. The advert does not mention guidelines, evidence, or outcomes, and fails to suggest any audit of the all important car buying cycle. Indeed cycles of any kind are the last thing on Nicole's mind and Papa is clearly not interested in setting standards against which to measure performance. If a rational approach changed behaviour then our commercial breaks would surely be a lot duller. The lesson from Papa and Nicole is that people are more likely to act when they feel good, flattered, tantalised, powerful, sexy, or proud than when they are flooded with facts.

This is not to put down facts. But in motivational terms a good story is worth a dozen facts. Medicine after all is structured around the endless (hi)stories that patients bring, and “I had a patient who” is almost always more memorable than “I read a paper that.” We run on stories not facts, because this is how, over past millenniums, we made sense of our worlds. Today that need to derive meaning through story, myth, and metaphor is played out on ward rounds and in the surgery, in casualty departments and the ambulance, and in the detailed, intuitive, sense making way in …
Gonococcal Urethritis In Vietnam
Authors: Richard W. M. Dang
Journal: JAMA (1969)

<h3>To the Editor:—</h3> The article on gonococcal urethritis in males in Vietnam (<b>207</b>:946, 1969) could not be considered applicable to gonorrhea in the United States, for sociological and epidemiological reasons. The number of patients infected with relatively penicillin-resistant gonorrhea was not determined. There was a two-week period between the initial diagnosis and onset of treatment and the retesting for infection. In the patients receiving medication orally, as with tetracycline, there was no confirmation that the patients took the medication as prescribed. The patients who were "laboratory positive" after the two-week period were labeled "treatment failures." It would appear possible that most of these were actually cases of reinfection.
Drug Interactions With Anticoagulants
Authors: Leonard T. Sigell
Journal: JAMA (1970)

Combined or multiple drug therapy has become an accepted fact in medical practice. A study of<i>hospitalized</i>patients at the Johns Hopkins Hospital revealed that these patients received an average of 13 different drugs during their hospital stay.<sup>1</sup>The Division of Clinical Pharmacology at the University of Cincinnati surveyed prescriptions for 821<i>outpatients</i>of the Cincinnati General Hospital medical clinics. Although 15% of these patients were not treated with drugs, a few patients received as many as eight drugs at one time. The average was two drugs per patient. In a study from Florida, ambulant patients admitted taking an average of 3.5 different drugs (including over-the-counter drugs) during the two months<i>prior</i>to their outpatient clinic visit. Only 9% of these patients denied taking any drugs.<sup>2</sup>The incidence of adverse drug reactions has been shown to increase as the number of drugs taken concurrently increases.<sup>3</sup>Therefore, it
Renal graft dysfunction during infection with cytomegalovirus: association with IgM lymphocytotoxins and HLA-DR3 and DR7.
Authors: W M Baldwin, F H Claas, A van Es, W L Westedt, G van Gemert, M R Daha, L A van Es
Journal: BMJ (1983)

Of 121 consecutive adult recipients of cadaver renal transplants who were treated with low dose steroids and azathioprine, 23 developed active cytomegalovirus infections. These 23 patients were divided into three groups on the basis of their symptoms related to the infection: five patients had no renal, respiratory, or haematological abnormalities; seven had renal dysfunction; and nine had renal dysfunction plus respiratory or haematological abnormalities. Two patients were regarded as a separate group because their infections occurred two to four weeks after graft nephrectomy. All but three of the patients produced IgM or IgG lymphocytotoxins during their infections. In the patients with mild infections and in control patients without infections, however, these lymphocytotoxins were predominantly IgG antibodies that were not precipitated by 3.5% macrogol (polyethylene glycol). In contrast, 12 of the 16 patients with renal dysfunction during their infections had broadly reactive IgM lymphocytotoxins. These IgM lymphocytotoxins lysed T as well as B lymphocytes at 22 degrees C and were precipitated by 3.5% macrogol, suggesting that they were circulating as immune complexes. Rheumatoid factors were found in sera from nine patients with cytomegalovirus infections, seven of whom developed leukopenia or pneumonia, or both, in addition to renal dysfunction. Some of these immune responses associated with cytomegalovirus infection in transplant recipients may be genetically controlled since 10 of 11 patients positive for HLA-DR3 or DR7 produced IgM lymphocytotoxins.
Queries and Minor Notes
Authors: A. E. Hedback
Journal: JAMA (1907)

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