tbuckley/cabot-search huggingface dataset:
Reforming the NHS reforms
Authors: A W Macara
Journal: BMJ (1994)

Rather than improving efficiency, the reforms imposed on the NHS have increased bureaucracy, reduced patient choice, limited the range of core services, and led to inequity of treatment.In this paper I examine how the medical profession might help to solve these problems.Priorities must be set for health care since no government can afford all the possibilities offered by medical science.It is essential to forge a consensus of patients, carers, professionals, the public, and government if a system of priorities is to be equitable and just.We also need to be able to measure quality ofoutcome in health care.This requires consensus on what is the desired outcome and the development of appropriate guidelines, audit, and performance review.This is primarily a task for the health professions supported by management and by adequate investment.Basically, the government must reinstate the three traditional values of the NHS-equity, consensus, and regard for representative professional advice.
Anticoagulant Therapy in Ischemic Heart Disease
Authors: Bernard H. Pastor
Journal: JAMA (1965)

In the past few years numerous medical symposia have been published in book form. These volumes usually consist of the speakers' manuscripts assembled under a single cover and are not really textbooks in the classic sense. They frequently lack important attributes one would expect in a good textbook, which should be concise, readable, and well organized. One reviewer has rather aptly, if not too kindly, referred to them as "instant books." It is only fair to point out that symposium proceedings provide a valuable record for those physicians who are fortunate enough to attend the symposium but are unable to digest and assimilate in a few days an enormous amount of concentrated information. They also permit a physician who is unable to attend to participate vicariously by reading the material at his leisure. They rarely can provide a substitute, however, for a welldesigned book on the same subject. On Jan
Rupture of Polytetrafluoroethylene Arterial Femoral Prosthesis
Authors: Paul E. Walker
Journal: JAMA (1960)

The development of suitable homograft material and plastic prostheses has popularized arterial replacement procedures for the relief of major arterial occlusive disease in the extremities. Difficulties in storage and procurement of arterial homografts have led many surgeons to adopt the use of plastic prostheses as the material of choice. In addition, there have been difficulties with the homografts, including two reports of aneurysm formation in the femoral arterial replacements.1  Polyethylene (Dacron) and polytetrafluoroethylene (Teflon) are preferred by most surgeons.2Some experimental data indicate that polytetrafluoroethylene is the superior synthetic.3Having used polyethylene initially, woven polytetrafluoroethylene was chosen as our standard material over one year prior to the time of writing, because of ease of handling and its low porosity. The low porosity of this material has permitted more extensive bypass procedures with less loss of blood than with polyethylene.  However, recently two cases of false aneurysm formation
Reducing the gap
Authors: E. L Lloyd
Journal: BMJ (2009)

Non-invasive high-frequency oscillatory ventilation (NHFOV) consists of the application of a bias flow generating a continuous distending positive pressure with superimposed oscillations, which have constant frequency and active expiratory phase. NHFOV matches together the advantages of high-frequency ventilation (no need for synchronisation, high efficacy in removing CO<sub>2</sub>) and nasal continuous positive airway pressure (CPAP) (non-invasive interface, increase in functional residual capacity allowing oxygenation to improve). There is enough clinical expertise demonstrating that NHFOV may be tried in some selected cases, in whom CPAP or conventional non-invasive ventilation have failed. Nonetheless, there are no clear data about its clinical usefulness and there is a need for randomised controlled studies. Our purpose is to review the physiology and biological effects of NHFOV, to present the current clinical evidence on its use, to provide some guiding principles to clinicians and suggest directions for further research.
Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: randomised controlled study
Authors: Guillaume Vaiva, Guillaume Vaiva, François Ducrocq, Philippe Meyer, Daniel Mathieu, Alain Philippe, Christian Libersa, Michel Goudemand
Journal: BMJ (2006)

<h3>Abstract</h3> <b>Objective</b> To determine the effects over one year of contacting patients by telephone one month or three months after being discharged from an emergency department for deliberate self poisoning compared with usual treatment. <b>Design</b> Multicentre, randomised controlled trial. <b>Setting</b> 13 emergency departments in the north of France. <b>Participants</b> 605 people discharged from an emergency department after attempted suicide by deliberate self poisoning. <b>Intervention</b> The intervention consisted of contacting patients by telephone at one month or three months after discharge from an emergency department for attempted suicide to evaluate the success of recommended treatment or to adjust treatment. Control patients received treatment as usual, in most cases referral back to their general practitioner. <b>Main outcome measures</b> The primary outcome measures were proportion of participants who reattempted suicide, number of deaths by suicide, and losses to follow-up at 13 months9 follow-up. Secondary outcome measures were types and number of contacts with health care. <b>Results</b> On an intention to treat basis, the three groups did not differ significantly for further suicide attempts, deaths by suicide, or losses to follow-up: contact at one month (intervention 23% (34/147) <i>v</i> controls 30% (93/312), difference 7%, 95% confidence interval − 2% to 15%), three months (25% (36/146) <i>v</i> 30%, difference 5%, − 4% to 14%). Participants contacted at one month were less likely at follow-up to report having reattempted suicide (12% <i>v</i> 22% in control group, difference 10%, 2% to 18%). <b>Conclusion</b> Contacting people by telephone one month after being discharged from an emergency department for deliberate self poisoning may help reduce the number of reattempted suicides over one year.
Long-Term Remission of Chronic Hepatitis B after Alpha-Interferon Therapy
Authors: J Korenman, B Baker, J Waggoner, J E Everhart, A M Di Bisceglie, J H Hoofnagle
Journal: Annals of Internal Medicine (1991)

Objective: To evaluate whether remissions of chronic hepatitis B induced by alpha-interferon therapy are of long duration. Design: Cohort study. Setting: Clinical Center of the National Institutes of Health, a tertiary referral center. Patients: Sixty-four patients with chronic hepatitis B were treated with alpha-interferon between 1984 and 1986. Main Outcome Measures: Patients were followed with frequent examinations and determinations of serum liver biochemical tests and hepatitis B virus (HBV) markers including hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and HBV DNA using blot hybridization and polymerase chain reaction. Results: Among 64 patients with chronic hepatitis B who were treated with alpha-interferon, 23 (36%) responded to treatment with loss of HBeAg and improvement in serum aminotransferases. All 23 have been followed for 3 to 7 years (mean, 4.3 years). During follow-up, 3 of 23 patients relapsed, with reappearance of HBeAg and abnormal serum aminotransferases, all within 1 year of therapy. The remaining 20 patients continued to have no detectable HBeAg or HBV DNA (using blot hybridization) in serum and to be asymptomatic for liver disease, although 3 had minimal elevations in serum aminotransferases. Thirteen patients (65%) became negative for HBsAg between 0.2 and 6 years (mean, 3 years) after loss of HBeAg. Although no patient had HBV DNA that was detectable by blot hybridization, the 7 patients who remained HBsAg positive all had HBV DNA in serum detected by polymerase chain reaction, but only 2 of 13 HBsAg-negative patients had viral genome using this method. Testing sequential samples indicated that HBV DNA detected by polymerase chain reaction usually disappeared at or around the time that test results for HBsAg became negative. Conclusions: Remissions in chronic hepatitis B induced by alphainterferon are of long duration and are followed, in most patients, by the loss of HBsAg and all evidence of residual virus replication.
Arrhythmogenic action of endothelin-1
Authors: B Merkely
Journal: Cardiovascular Research (2000)

Dear Editor, ischemic ECG changes and yielded a prompt fall in It was highly interesting to read the 'Letter to the Editor' coronary blood flow.Due to 1 nmol ET-1 bolus, MAP by Duru et al. [1] regarding the arrhythmogenic action of shortening and the decrease of the upstroke velocity in endothelin-1 (ET-1).ET-1 is supposed to act as a paracrine LV MAP signals were observed (ischemic effect) folepi hormone released due to stretch or myocardial ischaemia lowed by an increase of MAPD in the reperfusion period 90
Case 22-1981
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely, C. A. Hales, E. J. Mark
Journal: New England Journal of Medicine (1981)

Presentation of CaseA 58-year-old man was admitted to the hospital because of dyspnea and cough.He was well until one year earlier, when he began to experience progressive exertional dyspnea and a persistent cough that occurred in paroxysms once or twice daily and was productive of small amounts of whitish sputum. He began a weight-reduction diet, and his weight fell from 86 to 76 kg. Anorexia developed, accompanied by loss of an additional 5 kg in weight. During the five months before admission the exertional dyspnea rapidly became more severe. Three months before entry he became aware of a . . .
Predictive Factors and Long-Term Clinical Consequences of Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation With a Balloon-Expandable Valve
Authors: Marina Urena, Michael Mok, Vicenç Serra, Eric Dumont, Luis Nombela-Franco, Robert DeLarochellière, Daniel Doyle, Albert Igual, Eric Larose, Ignacio Amat-Santos, Mélanie Côté, Hug Cuéllar, Philippe Pibarot, Peter de Jaegere, François Philippon, Bruno Garcia del Blanco, Josep Rodés-Cabau
Journal: Journal of the American College of Cardiology (2012)
THE INTERALLIED SURGICAL CONFERENCE
Authors: Berkeley Moynihan
Journal: JAMA (1925)

<h3>To the Editor:</h3> —On page 281,The Journal, July 25, appears the following statement from your Belgian correspondent: "It was also Depage who, together with his friend Tuffier, induced the allied governments to establish at Paris an interallied surgical conference. The great work accomplished by this conference and the far-reaching influence that it had on the evolution of modern war surgery are well known." In the interest of historical truth it may be desirable to point out that this statement is not accurate. During the war I had the honor to be chairman of the council of consultants attached to the British army. While in France in 1914-1915, I had inspired at Rouen the creation of the first medical society formed in connection with any of the allied armies. The success of this society, to which our French colleagues were invited, and to which by solid knowledge, vigor of declamation
Effects of supplemental oxygen on cardiac rhythm during upper gastrointestinal endoscopy: a randomised controlled double blind trial.
Authors: T E Bowling, C L Hadjiminas, R J Polson, J H Baron, R A Foale
Journal: Gut (1993)

To investigate the effects of supplemental oxygen on cardiac rhythm during gastroscopy, 103 patients aged over 60 were randomised to receive either supplemental oxygen or air at 2 litres/minute during the procedure. Pulse rate, blood pressure, oxygen saturation, and a Holter cardiac trace were monitored before, during, and for one hour after the gastroscopy. A wide range of electrocardiographic abnormalities were recorded in both oxygen and air groups, of which ventricular and supraventricular ectopic beats were the most common. There were no significant differences in the rate of occurrence of any clinically important cardiac abnormality either between the oxygen and air groups or between the three monitored periods before, during, and after gastroscopy. There were significantly fewer patients, however, with supraventricular extra systoles when oxygen was given during gastroscopy (p &lt; 0.05). Although supplemental oxygen during gastroscopy significantly improved oxygen saturation (p &lt; 0.001; 95% confidence intervals for the difference between the means: 2.9 to 4.7), there was no correlation between oxygen saturation and any electrocardiographic changes. It is concluded that electrocardiographic abnormalities are common in patients over 60, but this study found no evidence that they are induced by gastroscopy. Supplemental oxygen increases oxygen saturation but does not reduce the incidence of clinically important cardiac arrhythmias.
Keyhole surgery at Maidstone hospital raised "serious concerns," finds review
Authors: C. Dyer
Journal: BMJ (2014)

Patients were subjected to risky keyhole surgery for upper gastrointestinal cancers at Maidstone Hospital, Kent, without proper informed consent, a review team from the Royal College of Surgeons has concluded.1

Maidstone and Tunbridge Wells NHS Trust suspended the laparoscopic surgery and called in the team last July after five patients died in a seven month period. The report, which found “serious concerns” about the service and recommended that it be suspended indefinitely, was delivered to the trust last December but has only now been published after pressure from patients and their families.

The royal college reviewers found a high complication rate associated with the laparoscopic procedures, which were performed by three …
THE RELATIONS OF MATTER AND MIND.Read at the Annual Meeting of the Indiana State Medical Society, May 16, 1894.
Authors: JAS. F. HIBBERD
Journal: JAMA (1894)

In the near future the most important and useful progress in medicine will be along biologic lines. Biology is the science of living things; in the broader sense covering all vital processes; teaches the phenomena concerning the genesis, the development, decline and death of all vital organisms. To my mind it is a self-evident proposition that a physician should fully understand the cytogenesis, the morphology, the histology, the anatomy, the physiology and the pathology of man, and as man is a microcosm of animated nature it is but a corollary that a perfect physician must be a thorough biologist. In the matter of the biology of the human mind there is abroad a great popular misunderstanding, and I am apt to believe that physicians have not given such attention to the relations of matter and mind as to leave no shadow of dubiety in the premises in their own minds.
Excretion of F2-isoprostanes in bile: A novel index of hepatic lipid peroxidation
Authors: Joseph A. Awad, Jason D. Morrow
Journal: Hepatology (1995)

Lipid peroxidation is believed to be an important mechanism of liver injury caused by some xenobiotics. However, it has been difficult to demonstrate and quantify this process in vivo. Moreover, little is known about the disposition of lipids oxidized in the liver. F 2 -isoprostanes are prostanoids produced by nonenzymatic free radical-catalyzed peroxidation of arachidonic acid esterified to phospholipids. Hydrolysis of F 2 -isoprostanes from phospholipids by phospholipases yields free F 2 -isoprostanes. Excretion of F 2 -isoprostanes, both free and esterified to phospholipids, was measured in bile after administration of CCI 4 . The concentration of lipid-esterified F 2 -isoprostanes in bile exceeded that of free F 2 -isoprostanes. CCI 4 , caused a dose-dependent increase in biliary F 2 -isoprostane excretion that correlated better with the increase in liver F 2 -isoprostaes than it did with the increase in plasma F 2 -isoprostanes. Pretreatment with colchicine ameliorated CCI 4 -liver injury but did not affect baseline or CCI 4 -induced biliary F 2 -isoprostane excretion. Administration of diquat to selenium-deficient rats, which causes hepatic and renal necrosis, was associated with a 13-fold elevation of plasma F 2 -isoprostanes. However, both hepatic F 2 -isoprostane concentrations and biliary F 2 -isoprostane excretion were increased only threefold. These data suggest that quantification of F 2 -isoprostane excretion in bile may provide a sensitive and quantitative index of hepatic lipid peroxidation. (Hepatology 1995; 22:962-968.)
Thrombocytopenia in Malaria with Immunoglobulin (IgM) Changes
Authors: P. J. Beale, J. D. Cormack, T. B. N. Oldrey
Journal: BMJ (1972)

Of 33 cases of naturally occurring human malaria 32 were found to have significant thrombocytopenia. Only one patient showed signs of bleeding. The lowest platelet levels were found between the day of diagnosis and the fourth day of treatment. Thereafter they returned to normal values. No other factors could be found to correlate with the presence or depth of thrombocytopenia, and no evidence of intravascular coagulation was found in any case. A rise in the immunoglobulin IgM was found in all 13 cases in which it was estimated. Since thrombocytopenia can occur independently of intravascular coagulation the latter should be diagnosed and heparin given only after clotting factors have been shown to be depleted.
A Clinical Lecture on Pulmonary Abscess: Delivered at the Hospital for Consumption and Diseases of the Chest, Brompton
Authors: R. J. Godlee
Journal: BMJ (1899)

IT is not exactly easy to say what is meant by abscess of the lung.In other parts of the body we do not meet with the same difficulty." A circumscribed collection of pus " answers well enough as a definition.It will include all possible conditions except the very chronic and very rare " lymph abscess " in which the contents are not purulent, but a clear fluid.But in the lung it may be said to be either too inclu- sive or not inclusive enough; it hardly includes bronchiec- tasis, which, from the surgical point of view-, merits, at all events, discussion in this connection, and it certainly does include some tuberculous cavities whieh, from the medical point of view, should scarcely be included in the category.Dr. J. Kingston Fowler, in a work I ought perhaps hardly to refer to, says that an abscess may be met in connection with:I. Pneumonia followed by necrosis and softening of a considerable area of the consolidated lung.2. Pulmonary tuberculosis, when a large carious area undergoes rapid disintegration.3. Chronic non-tuberculous cavities.4. Bronchiectasis, eitlher with or witlhout ulcerative changes in the bronchial walls anid surrounding tissues.5. Suppuration of a hlydatid cyst. 6. Softening of a py.-cinic infarction. 7. Pulmoinary embolismn followed by softening.8. Perforation of the lung by a malignant growth in the cmsophagus. 9. Suppuration of bronclhial glands extending into the lung.IO. Empyeina rupturing into the lung.'I. Perforation of the lung by a mediastinal abscess.I2. Perforation by aii abscess extending through the diaphragm.13. Injuries of the llg.I, i1899.
UNDULANT FEVER AS A PUBLIC HEALTH PROBLEM
Authors: THOMAS G. HULL
Journal: JAMA (1927)

Malta fever in man was first described in the United States by Craig,<sup>1</sup>in 1903. In Europe, the relation of the disease in man and in goats had been recognized for a long time, with<i>Brucella melitensis</i>as the infecting organism. Craig says: "There are no pathognomonic symptoms of Malta fever. The symptoms observed are so inconstant and confusing that no one of them can be said to be typical of the disease. A differential diagnosis is almost impossible in the majority of cases without the aid of the microscope and the serum test." A multitude of names have hence been used to describe the disease; according to Keefer,<sup>2</sup>"undulant fever or febris undulans (from the wavelike accessions of fever); Malta, Maltese, Mediterranean, Gibraltar or "rock," Neopolitan and Cyprus fever (from the geographic distribution); slow, mountain continued, goat fever (in Texas and New Mexico); Mediterranean phthisis (from the
Prepapillary Intradiverticular Bezoar as Cause of Obstructive Jaundice: Removed by Endoscopy
Authors: J. Armengol-Miró, M. Villagrasa, J. Formiguera, F. Ramentol, P. Prim, J. Guardia, J. Gomez
Journal: Endoscopy (1977)

Obstructive jaundice was cured in a 70-years-old woman after endoscopic removal of a bezoar located in a prepapillary duodenal diverticulum.
ST. GEORGE'S HOSPITAL: TWO CASES OF EXCISION OF THE KNEE-JOINT, WHICH TERMINATED FATALLY
Authors: T. Holmes
Journal: BMJ (1856)

IT is with no intention of depreciating the advantages, or unduly insisting on the risks of an operation, which has now taken its place among the ordinary resources of sur- gery, that I call attention to the occurrence of two fatal cases of excision of the knee-joint, which have recently
Wife wins case against GPs who did not disclose husband s HIV status
Authors: C. Zinn
Journal: BMJ (2003)

In a landmark case about patient confidentiality, two GPs in Australia have been successfully sued for breach of contract and for negligence for failing to ensure that a man who tested positive for HIV told his wife about the result.

The woman, known as PD and who contracted the infection, has been awarded $A720 000 (£288 000; $US473 400; ‡404 200) by the Supreme Court of New South Wales, which found that the doctors should not have assumed she would have been informed (24 May, p 1107).

The 28 year old woman and the man from …