tbuckley/cabot-search huggingface dataset:
DEATH RATE OF NITROUS OXID
Authors: J. F. Baldwin
Journal: JAMA (1923)

<h3>To the Editor:</h3> —I was greatly surprised to read in Queries and Minor Notes (The Journal, July 28, p. 320) that the "accepted" mortality rate from nitrous oxid is "about 1 death in 1,000,000 anesthesias." In the<i>New York Medical Record</i>, July 29, 1916, I reported fourteen nitrous oxid deaths that had occurred in Columbus alone, with full details of each death. Gwathmey, in his review on anesthesia in the<i>New York Medical Journal</i>, Oct. 28 and Nov. 4, 1916, states that "gas should never be used alone, as it is unsafe for even<i>short</i>operations." The same writer in the<i>Annals of Surgery</i>, August, 1921, in writing of nitrous oxid-oxygen, states that the advocates of this anesthetic agent "are probably responsible for more deaths than are the advocates of any one anesthetic or single method." Since the communication to the<i>Medical Record</i>, nitrous oxid-oxygen has been little used as
Extensive Hypertensive Work-up
Authors: Frank A. Finnerty
Journal: JAMA (1975)

ALTHOUGH I readily agree with Dr. Melby that patient noncompliance is the major problem in the long-term treatment of hypertension, the extensive and expensive routine diagnostic work-up that he advocates for every hypertensive patient would aggravate rather than solve the problem. In my experience, both in private practice and in the clinic, the average asymptomatic patient is not willing to spend the time or the money to undergo a battery of tests. Gifford found that less than 6% of 5,000 hypertensive patients examined consecutively at the Cleveland Clinic had secondary hypertension; I would thoroughly agree with Gifford's conclusion that an exhaustive search for the rare types of hypertension in every patient is not warranted. Even if 35% of the hypertensive population has some form of secondary hypertension that can be treated specifically (and most authorities would agree that this estimate is far too high), why must every hypertensive patient be
The Cambridge Illustrated History of Medicine/The Oxford Illustrated Companion to Medicine
Authors: Mark Powlson
Journal: BMJ (2002)

Ed Roy Porter 

Cambridge University Press, £19.95, pp 400

ISBN 0 521 00252 4

Third edition 

Eds Stephen Lock, John M Last, George Dunea 

Oxford University Press, £39.50, pp 891

ISBN 0 19 262950 6

Rating: ![Graphic][1] ![Graphic][2] ![Graphic][3] ; ![Graphic][4] ![Graphic][5] ![Graphic][6] ![Graphic][7] 

Rarely does the BMJ publish reviews of reprints or new editions, and rarer still entrust something edited by one of its former editors to a former reviews editor of the Lancet . However, the quality of both of these books shines through. Comparisons of two such worthy works are invidious, but here (although not quite so evident in recent years in the Boat Race) the dark blues—Oxford—have it over the light blues—Cambridge—although, strictly speaking, they are …

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Palliation of Carcinomatosis with Ascites by Means of Hemisulfur Mustard (2-Chloro-2′-Hydroxydiethyl Sulfide)
Authors: Alexander M. Rutenburg, Arnold M. Seligman
Journal: New England Journal of Medicine (1956)

THE preparation of hemisulfur mustard, the rationale that led to discovery of its palliative properties and its effect after administration to patients with malignant tumors have been reported. § When palliation was observed, it generally consisted of suppression of ascitic-fluid formation in patients with peritoneal carcinomatosis as well as decrease in size of any tumor masses present, and of decrease in pain and increase in appetite, strength and ability to get around. The greatest benefit was observed in patients with carcinoma of the ovary.The present report deals with improvement in the method of administration and presents the results of treatment . . .
Letter: Changing patterns of cancer.
Authors: J R Belcher
Journal: BMJ (1976)

intervertebral joint space widens.Hence intermittent or pulsating traction acts merely on muscles, evoking the stretch reflex but not the suction that determines the effect on the pro- trusion.The absolute contraindication to traction is acute lumbago.2Though pain and signs cease while the pull is maintained, the slightest diminution in tension causes such agonising twinges that it takes several hours to get the patient off the couch, and some aggravation
Heart and science
Authors: T. Dalrymple
Journal: BMJ (2012)

Wilkie Collins (1824-1889) was addicted to laudanum (tincture of opium in alcohol) for much of his life, but that did not prevent him from producing a vast corpus of work. Among his novels is Heart and Science , published in 1883, known (in so far it is known at all) for its protest against vivisection.

It is not a good novel, to put it mildly, and it would take several pages of convoluted prose to summarise its preposterous plot. But it has much, from character to incident, to interest the medical reader. There is the hero, a brilliant but exhausted young surgeon called Ovid Vere; an ineffectual family doctor, the aptly named Mr Null, who “submitted to …
Intracranial hypertension and nasal fluticasone propionate
Authors: M. Oko, A. Johnston, I. R C Swan
Journal: BMJ (2001)

Mercury sphygmomanometers: disposal has far reaching consequencesEditor-The papers by O'Brien and Beevers et al have documented the trend away from the use of the mercury sphygmomanometer. 1 2 But the ethical, legal, economic, and public health consequences associated with their disposal have not been so well documented.This lack of advice is surprising since mercury has well known toxic properties.Haphazard disposal of mercury inevitably leads to environmental recycling and bioconcentration, with ecological damage at best and human poisoning at worst. 3 The Special Waste Regulations 1996 classify mercury and waste material containing more than 3% mercury as special waste and require extensive documented control of, and the use of approved contractors for, each stage of the disposal process.Noncompliance can result in a major fine, together with a custodial sentence.Although technically only the mercury component is special, it would not be safe for staff to break sphygmomanometers open to access the mercury in uncontrolled conditions.In addition, we considered it likely that standard mercury containing sphygmomanometers used in general prac-tice in England and Wales would contain more than 3% mercury and should therefore be considered special waste.We obtained four intact mercury sphygmomanometers from a general practitioner's surgery and drained and weighed the mercury under laboratory conditions.Each contained more than 3% mercury (average 6.5%).The NHS must develop a policy for the storage and ultimate disposal of retired mercury sphygmomanometers that accords with the Special Waste Regulations 1996.Data from Birmingham health authority show that more than 30 000 mercury sphygmomanometers are still in active use by general practitioners in the UK.If plans are not made to dispose of these sphygmomanometers safely, some 1800 kg of mercury could enter the environment.The contamination that would result from the haphazard disposal of all mercury sphygmomanometers used in the NHS would be much greater, and the volumes involved suggest that collection and recycling may be commercially viable.What should general practitioners, hospitals, and other NHS trusts do?Expecting each to negotiate a suitable system of collection and disposal would be burdensome, inefficient, and impractical, although it is their legal responsibility to do so.We are working with the environment agency in our region to develop an approved scheme that will reduce the bureaucratic demands on individual practices while protecting them from statutory action and, at the same time, provide a safe, efficient, and cost effective storage, transport, and disposal service.
A seasonal cost effectiveness analysis: the last Noel?
Authors: D. Isaacs
Journal: BMJ (2002)

Health economists are ideologically opposed to frivolity. It has come to our attention that an annual, quasireligious festival has been held for some years without having been subjected to the rigours of a cost effectiveness analysis. In these sombre days of economic rationalism, such an oversight is unconscionable. The money spent on gifts and wrapping paper, tinsel and turkey is a significant opportunity cost, which might be better spent on improving the health care of the nation. We present a cost effectiveness analysis of Christmas.

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Our cost effectiveness analysis was carried out from a societal perspective, using clinical and economic variable estimates, derived by inspired guesswork. We assumed that the average doctor has no knowledge or interest in accountancy and will accept anything a health economist tells him or her without question; …

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Pneumonia and ACE inhibitors--and cough
Authors: R. A. Barnes
Journal: BMJ (2012)

Too early to use ACE inhibitors to prevent pneumonia

Angiotensin converting enzyme (ACE) inhibitors are widely used to treat heart failure and hypertension. They act through blocking the conversion of angiotensin I to angiotensin II; this inhibits the breakdown of bradykinin, which in turn lowers arteriole resistance and increases venous return. Many patients taking ACE inhibitors experience a persistent dry cough, which is thought to be caused by increased concentrations of bradykinin; the cough is triggered by the endothelial effects of bradykinin and other peptides. Refractory cough is the most common reason for switching from ACE inhibitors to angiotensin II receptor blockers (ARBs), which do not inhibit the breakdown of kinins and are less likely to cause troublesome coughing. In the linked study (doi:10.1136/bmj.e4260), Caldeira and colleagues examined the risk of pneumonia with both classes of drug, hypothesising that the cough associated with ACE inhibitors might protective against pneumonia.1

Coughing is one of the most common reasons that patients consult a primary care doctor, and it has a substantial effect on quality of life. It also …
Relationship Between Spontaneous and Iatrogenic Hypoglycemia and Mortality in Patients Hospitalized With Acute Myocardial Infarction
Authors: Mikhail Kosiborod
Journal: JAMA (2009)

While glucose control is recommended by professional societies for patients with hyperglycemia hospitalized with acute myocardial infarction (AMI), enthusiasm for glucose lowering is tempered, in part, by concerns of inducing hypoglycemia. Yet, whether episodic hypoglycemia that occurs as a result of glucose-lowering therapy is harmful in patients with AMI is unknown.To determine whether the mortality risk associated with hypoglycemic events is similar in patients who develop hypoglycemia spontaneously and those who develop it as a result of insulin therapy.Retrospective cohort study using data from Health Facts, a contemporary database of patients hospitalized across the United States in 40 hospitals between January 1, 2000, and December 31, 2005. Of all the patients in the database, 7820 patients were hospitalized with AMI and were hyperglycemic on admission (glucose level > or = 140 mg/dL). Patients were stratified based on whether they developed a hypoglycemic event (random glucose level < 60 mg/dL) during subsequent hospitalization. Logistic regression models were used to evaluate the association between hypoglycemia and in-hospital mortality within subgroups of patients who were and were not treated with insulin therapy.All-cause in-hospital mortality.Among patients treated or not treated with insulin, those with hypoglycemia were older and had more comorbidity. Hypoglycemia was associated with increased mortality in patients not treated with insulin (18.4% [25/136] mortality in patients with hypoglycemia vs 9.2% [425/4639] in those without hypoglycemia; P<.001), but not in those treated with insulin (10.4% [36/346] mortality in patients with hypoglycemia vs 10.2% [276/2699] in those without hypoglycemia; P = .92). After multivariable adjustment, there was a significant interaction between hypoglycemia and insulin therapy (P value for interaction = .01). Hypoglycemia was a predictor of higher mortality in patients who were not treated with insulin (odds ratio, 2.32 [95% confidence interval, 1.31-4.12] vs patients without hypoglycemia), but not in patients treated with insulin (odds ratio, 0.92 [95% confidence interval, 0.58-1.45] vs patients without hypoglycemia).While hypoglycemia was associated with increased mortality in patients with AMI, this risk was confined to patients who developed hypoglycemia spontaneously. In contrast, iatrogenic hypoglycemia after insulin therapy was not associated with higher mortality risk.
Teenagers in England to be vaccinated against meningitis group W
Authors: J. Wise
Journal: BMJ (2015)

Teenagers in England are to be vaccinated against meningitis W after a worrying rise in the incidence of meningococcal group W disease since 2009.

The Joint Committee on Vaccination and Immunisation has recommended that a vaccination programme for 14-18 year olds should be implemented as soon as possible, to generate herd protection against meningitis W for the rest of the population. The independent advisory committee said, “Levels of disease were consistent with an outbreak situation, with cases and deaths occurring in all age ranges, constituting a public health emergency.”

The Department of Health for England has accepted the advice and …
The Brady Bunch? New evidence for nominative determinism in patients' health: retrospective, population based cohort study
Authors: J. J. Keaney, J. D. Groarke, Z. Galvin, C. McGorrian, H. A. McCann, D. Sugrue, E. Keelan, J. Galvin, G. Blake, N. G. Mahon, J. O'Neill
Journal: BMJ (2013)

To ascertain whether a name can influence a person's health, by assessing whether people with the surname "Brady" have an increased prevalence of bradycardia.Retrospective, population based cohort study.One university teaching hospital in Dublin, Ireland.People with the surname "Brady" in Dublin, determined through use of an online telephone directory.Prevalence of participants who had pacemakers inserted for bradycardia between 1 January 2007 and 28 February 2013.579 (0.36%) of 161,967 people who were listed on the Dublin telephone listings had the surname "Brady." The proportion of pacemaker recipients was significantly higher among Bradys (n=8, 1.38%) than among non-Bradys (n=991, 0.61%; P=0.03). The unadjusted odds ratio (95% confidence interval) for pacemaker implantation among individuals with the surname Brady compared with individuals with other surnames was 2.27 (1.13 to 4.57).Patients named Brady are at increased risk of needing pacemaker implantation compared with the general population. This finding shows a potential role for nominative determinism in health.
Human platelet-initiated formation and uptake of the C5-9 complex of human complement.
Authors: T S Zimmerman, W P Kolb
Journal: Journal of Clinical Investigation (1976)

We have studied the interaction of radiolabeled complement components with normal human platelets, platelets from a patient with paroxysmal nocturnal hemoglobinuria, and rabbit platelets in the absence of known complement activators or in the presence of cobra venom factor (CVF). When unwashed platelets in platelet-rich plasma, or washed platelets suspended in serum or autologous plasma, were incubated for 30 min, C3 and terminal components (C5, C8, and C9) were found to bind to them. The terminal components were shown to be bound as the C5-9 complex, rather than as individual proteins, by eluting them from the platelet membrane and examining their behavior on ultracentrifugation. They cosedimented at a rate characteristic of the stable C5-9 complex (22S). As many as 370-1,380 C5-9 complexes/platelet were calculated to have been bound during the incubation period. The complex so formed did not differ by ultracentrifugational criteria from that binding to rabbit platelets after CVF activation of complement. Though C3 was not included in the complex, it did not appear to be bound by nonspecific absorption. It could not be removed by washing but rather was eluted by the freeze-thaw technique used to elute the C5-9 complex. Incubation of radiolabeled components in platelet-free plasma did not result in C5-9 complex formation, indicating an initiating role for platelets in this reaction. In contrast to platelets, erythrocytes incubated in analogous plasma did not induce detectable C5-9 formation. Neither EDTA, phenylmethylsulfonylfluoride, nor epsilon-amino-N-caproic acid prevented platelet-initiated formation of C5-9, suggesting that the reaction may involve mechanisms of complement activation not previously described.
Adolescents and Their Music
Authors: Elizabeth F. Brown
Journal: JAMA (1989)

During adolescence, teenagers are expected to develop standards of behavior and reconcile them with their perceptions of adult standards. In this context, music, a powerful medium in the lives of adolescents, offers conflicting values. The explicit sexual and violent lyrics of some forms of music often clash with the themes of abstinence and rational behavior promoted by adult society. Identification with rock music, particularly those styles that are rejected by adults, functions to separate adolescents from adult society. Some forms of rock music extend well beyond respectability in fulfilling this definitional role. Total immersion into a rock subculture, such as heavy metal, may be both a portrait of adolescent alienation and an unflattering reflection of an adolescent's perception of the moral and ethical duplicity of adult society. Physicians should be aware of the role of music in the lives of adolescents and use music preferences as clues to the emotional and mental health of adolescents.
Tuberculous Synovitis of the Hip Joint Diagnosed by FDG PET-CT
Authors: William Makis, Gad Abikhzer, Jerry Stern
Journal: Clinical Nuclear Medicine (2009)

A 61-year-old woman with a history of lupus had a Positron emission tomography-computed tomography (PET-CT) scan as part of a malignancy workup for new cerebellar lesions. She had presented with new onset headaches. A CT scan of the thorax, abdomen, and pelvis, done 2 months earlier, had only shown an asymptomatic left hip joint effusion that was attributed to a nonerosive synovitis, possibly caused by her lupus. The PET-CT now showed extensive left acetabular and femoral head destructive bone lesions that had progressed significantly in 2 months, with associated intense 18F-fluoro-2-deoxy-glucose (FDG) uptake (maximal SUV 8.7). The left hip joint effusion also had intense FDG uptake. The hip joint was aspirated following the PET scan, and the synovial fluid grew mycobacterium tuberculosis. The PET-CT also showed an enlarged left iliopsoas bursa, which did not have FDG uptake and was therefore probably not infected.
Propranolol Withdrawal and Myocardial Infarction
Authors: Allan Flach
Journal: JAMA (1981)

<h3>To the Editor.—</h3> The article by Nair et al (1980;243:1552), "Acute Myocardial Infarction in Idiopathic Hypertrophic Subaortic Stenosis," describes an unusual case of acute myocardial infarction in a young patient with idiopathic hypertrophic subaortic stenosis that the authors explain was related to strenuous exertion during cold temperature. Although the patient was described as receiving propranolol hydrochloride, 80 mg daily, in July 1976, no mention of present therapy or, more important, cessation of therapy is mentioned. Could this patient be another example of abrupt propranolol withdrawal resulting in acute myocardial infarction?<sup>1,2</sup>
Effect of nocturnal oxygen and acetazolamide on exercise performance in patients with precapillary pulmonary hypertension and sleep disturbed breathing. Randomized, double-blind, cross-over trial
Authors: Silvia Ulrich, Stephan Keusch, Florian Hildenbrand, Christian Lo Casio, Lars Huber, Felix Tanner, Rudolf Speich, Konrad Bloch
Journal: European Respiratory Journal (2013)

Background: Sleep disturbed breathing (SDB) is common in patients with precapillary pulmonary hypertension (PH) and impairs well-being. We tested whether nocturnal oxygen therapy (NOT) or acetazolamide improve exercise performance, quality of life and pulmonary hemodynamics in patients with precapillary PH and SDB.

Methods and results : This was a randomized, placebo-controlled, double-blind, cross-over trial. Participants received NOT (3l/min), acetazolamide tablets (2x250mg), and sham-NOT/placebo tablets each during 1 week with one-week washout between treatments periods. The trial included 23 patients (15 females, 16 with pulmonary arterial, 7 with chronic thromboembolic PH) on optimized pharmacological therapy, daytime PaO2 ≥7.2 kPa but either mean nocturnal oxygen saturation  10/h. Medians (quartiles) of the 6 minute walk distance on NOT, acetazolamide and placebo were 480m (390;528), 440m (368;468), 454m (367;510), respectively, mean difference (95% CI) NOT vs. placebo +25 m (3 to 46, p=.027); mean difference acetazolamide vs. placebo -9 m (-34 to 17, p=.23). SF-36 quality of life was similar on NOT, acetazolamide and placebo. Right ventricular fractional area change was greater on NOT compared to placebo (p=.042).

Conclusion: In patients with precapillary PH and SDB on optimized pharmacological therapy, NOT but not acetazolamide improved the 6 min walk distance compared to placebo already after one week. Therefore, NOT is promising as a long-term treatment for PH patients with SDB.

Trial Registration: Clinical trial.gov, [NCT01427192][1].

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Debate about blood pressure and epistaxis will continue
Authors: A. F P Temmel
Journal: BMJ (2001)

EDITOR—Manfredini et al in showed a circadian variation in the onset of epistaxis in their paper.1 Epistaxis is the second most common cause of spontaneous bleeding. Of the two categories of epistaxis, mundane and severe, the mundane, usually anterior epistaxis, is the more common. Manfredini et al did not, however, report on the subgroups of epistaxis.

Sixty per cent of …