tbuckley/cabot-search huggingface dataset:
Brain Versus Lung: Hierarchy of Feedback Loops in Single-Ventricle Patients With Superior Cavopulmonary Connection
Authors: Mark A. Fogel, Suzanne Durning, Gil Wernovsky, Avrum N. Pollock, J. William Gaynor, Susan Nicolson
Journal: Circulation (2004)

Background— CO 2 vasodilates and O 2 vasoconstricts the cerebral vascular bed; the opposite is true in the lungs. When the brain and lungs are connected exclusively in series, which feedback loop predominates is unknown. The circulation of the superior cavopulmonary connection (SCPC) provides a unique physiology to answer this question. Methods and Results— To determine cerebral and pulmonary blood flow and to establish the hierarchy of cerebral and pulmonary feedback mechanisms, 12 intubated, ventilated, single-ventricle patients in SCPC physiology (age 2.2±0.5 years) underwent magnetic resonance imaging velocity mapping of their jugular veins and aorta in room air, hypercarbia, and 100% O 2 . Flows in these vessels and arterial blood gases were measured. With 22±6 torr CO 2 (P co 2 increased from 40 to 63 mm Hg, P &lt;0.01), flow to the brain and lungs increased (1.5 to 2.7 L/min per m 2 , P =0.0003), P o 2 improved (48 to 60 mm Hg, P =0.0004), and cardiac index increased (4.3 to 5.4 L/min per m 2 , P =0.0003). The increased cardiac index accounted for the increased cerebral and pulmonary blood flow ( R =0.73, P =0.02) and cerebral O 2 transport increased by 80% ( P =0.0005) while preserving body O 2 delivery. Hyperoxia did not change cerebral and pulmonary blood flow; P o 2 increased 94% ( P =0.01). Conclusion— The cerebral CO 2 feedback loop predominates over the pulmonary one when they directly compete with each other. CO 2 has a major impact on flow distribution whereas O 2 has little impact. Increased CO 2 improves cerebral oxygenation in SCPC patients. This may provide a clue in determining neurological sequelae in SC physiology and may influence timing of Fontan completion.
Going the last mile in child survival in India
Authors: A. Jain
Journal: BMJ (2014)

It helps to have the right care, at the right time, from the right providers

The language of global public health seems to be punctuated by “gaps,” perhaps most starkly on the frontier of child survival where, despite concerted efforts, nearly 18 000 children under the age of 5 years continue to die every day. A large majority of these succumb to conditions such as pneumonia and diarrhoea, against a backdrop of pervasive undernutrition.1 More than half of them fail to receive appropriate and timely medical care.2 The knowledge and technologies to prevent or treat these conditions have long been established. However, taking these the last mile to improve health outcomes remains a challenge. A priority setting exercise by the World Health Organization accorded prime importance to research investigating the optimal use of known interventions for child health and the barriers to efficient delivery.3

The Integrated Management of Childhood Illnesses initiative launched in the early 1990s aims to foster early recognition of childhood illnesses by the family, enhanced linkages between communities and health facilities, and prompt and appropriate treatment delivered through strengthened …
Elevated plasma free drug concentrations of propranolol and diazepam during cardiac catheterization.
Authors: A J Wood, D Robertson, R M Robertson, G R Wilkinson, M Wood
Journal: Circulation (1980)

Patients who undergo cardiac catheterization are frequently taking propranolol and are often premedicated with diazepam. Because the intensity of a drug's action is determined by free, or non-protein-bound, levels in plasma, changes in the degree of protein binding may profoundly alter the pharmacologic effect. We examined the effects of heparin on the free levels of propranolol and diazepam in six patients who underwent cardiac catheterization. After heparinization, the free fraction of diazepam increased more than fourfold, from 1.8 +/- 0.1% to 7.9 +/- 1.2% (p < 0.002) and the free levels increased from 2.0 +/- 0.5 to 8.4 +/- 2.2 ng/ml (p < 0.025); the free fraction of propranolol increased from 7.4 +/- 0.9% to 12.5 +/- 1.4% (p < 0.001). The increase in free drug concentration was associated with elevated free fatty acid levels, which rose from 181 +/- 7 micrograms/ml to 596 +/- 119 micrograms/ml (p < 0.02). Increases in the free levels of propranolol and diazepam produced by heparinization during cardiac catheterization may result in increased pharmacolaogic effect, such as excessive sedation or respiratory depression.
Intestinal adaptation and experimental carcinogenesis after partial colectomy. Increased tumour yields are confined to the anastomosis.
Authors: R C Williamson, P W Davies, J B Bristol, M Wells
Journal: Gut (1982)

Small-bowel resection enhances experimental colorectal carcinogenesis, probably by stimulating epithelial cell proliferation. The possibility that similar mechanisms might explain metachronous large-bowel cancers in man was tested in Sprague-Dawley rats submitted to partial colectomy before or after a five-week course of azoxymethane (total dose 50 mg/kg). The timing of operation did not affect tumour yields at 40 weeks. Caecal resection augmented mucosal mass in the ileum and right colon but did not affect carcinogenesis. Right hemicolectomy only increased ileal segmental weight (by 22%); left hemicolectomy increased the protein and DNA contents of the residual right colon by 18-42%. Large-bowel tumours in 84 rats were distributed as follows: proximal colon 36, colonic anastomosis 51, distal colon 87, rectum 43. Consistent with this left-sided predominance, left hemicolectomy reduced the number of large-bowel tumours. A twofold increase in distal tumours after both transection and right hemicolectomy simply reflected the high incidence of anastomotic tumours. Furthermore, one rat given vehicle as opposed to carcinogen developed an invasive mucinous adenocarcinoma at the colorectal anastomosis, after left hemicolectomy. The large bowel shows limited adaptation to partial resection and is not at increased risk of carcinogenesis, except in the region of the suture line.
Inhibition of erythrocyte sickling in vitro by pyridoxal.
Authors: J A Kark, M P Kale, P G Tarassoff, M Woods, L S Lessin
Journal: Journal of Clinical Investigation (1978)

To test the antisickling activity of pyridoxal, we compared the oxygen affinity and the percent sickling at low PO2 of untreated erythrocytes with values for cells from the same blood sample incubated with pyridoxal, glyceraldehyde, or pyridoxine. Pyridoxal increased oxygen affinity much more than glyceraldehyde. 20 mM pyridoxal and glyceraldehyde had equivalent antisickling activity. At PO2 levels above 20 mm Hg, both agents reduced sickling to less than 2%. In samples examined by electron microscopy, pyridoxal reduced the percent sickled cells and the percent cells that contain hemoglobin S fibers by the same amount (from 74 to 3%). Pyridoxine had no effect on oxygen affinity or sockling. Pyridoxal reacts with intracellular hemoglobin to increase oxygen affinity, which inhibits hemoglobin S polymerization and sickling.
Accurate Estimation of Glomerular Filtration Rate in Diabetic Nephropathy From Age, Body Weight, and Serum Creatinine
Authors: Michael J Sampson, Paul L Drury
Journal: Diabetes Care (1992)

Objective To assess, in diabetic nephropathy, the accuracy of a method that estimates glomerular function with age, body weight, and serum creatinine as parameters. Research Desihn and Methods Glomerular filtration rate (GFR) was measured 57 times in 20 subjects with insulin-dependent diabetes mellitus and nephropathy with a single injection of 51Cr-EDTA. At the same time, the estimated creatinine clearance (ml/min) was calculated with the Cockroft-Gault formula These values were then corrected for body surface area (1.73 m2). Results For GFR measurements &amp;lt;100 ml · min−1 · 1.73 m−2 (n = 41), there was a strong positive correlation with the estimated creatinine clearance corrected for body surface area (r = 0.94, P &amp;lt;0.0001). The slope of this regression line did not differ significantly from identity or the y-intercept from zero. On average, the Cockroft-Gault formula (corrected for body surface area) underestimated the GFR by only 3.1 ml·min−1·1.73 m−2 (9.7 SD). Conclusions This formula, corrected for body surface area, gives accurate estimates of GFR when GFR &amp;lt;100 ml·min−1·1.73 m–2. This formula could be used with an acceptable degree of confidence when repeated isotope assessments of renal function in diabetic nephropathy are impracticable.
Multiple inhalers confuse asthma patients
Authors: J van der Palen, JJ Klein, CL van Herwaarden, GA Zielhuis, ER Seydel
Journal: European Respiratory Journal (1999)

This study investigated the influence of the use of different types of inhalers on the adequacy of inhalation technique among adult asthmatics. Three hypotheses were tested: first, patients using only one type of inhaler will demonstrate adequate inhalation technique more often than those with two or more types. Secondly, patients using a combination of dry powder inhalers (DPIs) will demonstrate correct inhalation technique more often than those using the combination of a metered dose inhaler (MDI) and a DPI. Thirdly, some inhalers or combinations of inhalers are more prone to erroneous inhalation technique than others. Adult outpatients with asthma who regularly used inhaled steroid therapy (n=321) participated in the study. The inhalers investigated were MDIs on the one hand, and the DPIs Turbuhaler, Diskhaler, Cyclohaler, Inhaler Ingelheim and Rotahaler on the other. Of 208 adult asthmatics with only one inhaler, 71% made no inhalation errors versus 61% of 113 patients with two or more different inhalers. Of patients with a combination of DPIs 68% performed all essential checklist items correctly, versus 54% of patients with the combination of "regular" MDI and DPI. Patients using only the Diskhaler made fewest errors. Whenever possible, only one type of inhaler should be prescribed. If a combination is unavoidable, combinations of DPIs are preferable to MDI and DPI. The Diskhaler seems to be the most foolproof device.
In-111 WBC Scan Localizes Infected Hepatic Cysts and Confirms Their Complete Resection in Adult Polycystic Kidney Disease
Authors: SABRINA A. LAHIRI, GLENN A. HALFF, K. VINCENT SPEEG, ROBERT M. ESTERL
Journal: Clinical Nuclear Medicine (1998)

Although hepatic cysts occur in 34-75% of patients with polycystic kidney disease (PKD), infection of hepatic cysts is rare. The detection of infected hepatic cysts in PKD presents diagnostic and therapeutic difficulties, especially when a focus of infected cysts exists with innumerable uncomplicated cysts. The authors describe a 44-year-old woman with PKD who had recurrent infected hepatic cysts that were previously treated with percutaneous drainage and antibiotics. CT revealed innumerable hepatic cysts, but no discrete focus of hepatic infection. An In-111 WBC scan, however, demonstrated intense uptake in the right superior posterior hepatic lobe, consistent with infected hepatic cysts. The patient underwent partial resection of the right hepatic lobe. The patient had no evidence of hepatic infection since resection. A postoperative In-111 WBC scan demonstrated normal uptake in the liver. The In-111 WBC scan not only identified the precise location of the infected hepatic cysts, but also confirmed their complete resection.
Predictive Value of Increased Ankle-Brachıal Index in Contrast Nephropathy Development Due to Coronary Angiography
Authors: Serkan Yıldırım, Mehmet Kayrak, Mehmet Doğuşcan Eriş, Hakan Akıllı, Yalçın Solak, Ahmet Lütfi Sertdemir
Journal: Journal of the American College of Cardiology (2013)
CD7 expression on CD34+ cells from chronic myeloid leukaemia in chronic phase
Authors: G.A. Mart�n-Henao, R. Quiroga, A. Sureda, J. Garc�a
Journal: American Journal of Hematology (1999)

Thirty-seven patients with chronic phase chronic myeloid leukaemia and fourteen healthy controls have been evaluated for lineage differentiation with immunological markers on purified bone marrow CD34 positive cells by multiparameter flow cytometry. The myeloid-associated antigen CD33 and the stem cell factor receptor (CD117, c-kit) was expressed by 82.3% and 73.5% on CP-CML patients and by 57% and 57.5% on healthy donors, respectively (P < 0.005). CD34+/CD19+ or CD34+/CD10+ B-lymphoid cell population represented 9.1% and 10.7% of the CD34+ cells in CML whereas in normal controls this subpopulation was expressed by 27.9% and 30.4% of the CD34+ cells, respectively (P< 0.005). The T-lineage associated markers (CD7 and CD2) were detected on a minor population of CD34+ BM cells of healthy controls (mean, 3.6% and 4.6%, respectively). The CD2 positive cells represented 1.5% of the CD34+ cells in CML patients. CP-CML patients co-expressed the CD7 antigen on a mean of 32.6% of the CD34+ BM cells. Moreover, 93% of this CD34/CD7 double positive subpopulation co-expressed CD33 antigen in CML patients. Co-expression of CD7 on CD34+ cells was induced to decrease significantly after short-term in vitro culture with the differentiation-inducing agent phorbol ester (PMA) and with a combination of cytokines (stem-cell factor, interleukin-3 and granulocyte colony-stimulating factor). In conclusion, a high co-expression of CD7 antigen is demonstrated on CD34+ cells of chronic phase-chronic myeloid leukaemia patients. The loss of CD7 marker following incubation with PMA and cytokines suggests that this antigen is expressed transiently in early myeloid leukaemic CML haemopoiesis. Am. J. Hematol. 61:178–186, 1999. © 1999 Wiley-Liss, Inc.
Leslie's Weekly's Partnership with Fraud.
Authors: E. C. Ellett
Journal: JAMA (1907)

Memphis, Tenn., July 11, 1907. <h3>To the Editor:</h3> —Your editorial entitled "Accomplice or Dupe," on page 48 ofThe Journal, July 6, in which you call attention to the elaborate notice given in<i>Leslie's Weekly</i>of the opening of a so-called hospital for the treatment of cancer by the Alexander method, should be supplemented with a notice of the fact that this periodical is prone to such offenses. About eighteen months ago an article was published under the heading "Is Blindness on the Increase," or something to that effect. The medical eye was at once attracted, and my disgust may be imagined when the thing proved to be an advertisement of the "cele-brated specialist," Dr. Oren Oneal. This article occupied a full page ordinarily devoted to reading matter, and was evidently intended to be taken for reading matter. Though a reader of<i>Leslie's</i>for several years, I at once dropped
Enteral nutrition and the small intestine.
Authors: A P Jenkins, R P Thompson
Journal: Gut (1994)

It is now accepted that, whenever possible, nutritional support should be given enterally, reserving parenteral nutrition for patients with intestinal failure.This is partly because of the many problems associated with parenteral feeding, such as complications of central line insertion and metabolic derangements,1 but recently it has also been appreciated that enteral feeding may have a positive advantage over parenteral feeding by maintaining small intestinal mucosal structure and function.Thus it may improve intestinal recovery and adaptation after gastrointestinal surgery, especially after small bowel resection.In addition, maintaining the barrier function of the intestinal mucosa may be an important consequence of enteral nutrition, for, in the critically ill, early enteral feeding may reduce translocation of bacteria and endotoxin from the gut lumen into the portal circulation,2 thus decreasing the incidence of septicaemia.3Recently, it has also been found that enteral nutrition influences the secretory function of the small intestine.In experimental animals starvation results in intestinal hypersecretion to neurotransmitters and secretagogues4-6 and such a response may contribute to the life threatening diarrhoea that can occur in patients with severe malnutrition.6This review will focus, however, on the effects of enteral nutrition on small intestinal mucosal proliferation, with particular emphasis on the actions of individual nutrients.
Decreased flares of rheumatoid arthritis during the first year of etanercept treatment: further evidence of clinical effectiveness in the "real world"
Authors: Y Yazici
Journal: Annals of the Rheumatic Diseases (2002)

<b>Objective:</b> To determine the incidence of disease flare during the first year of etanercept treatment for 88 patients with rheumatoid arthritis (RA) and compare it with the incidence of flare in those same patients in the year before etanercept use. <b>Methods:</b> The outpatient clinic charts of all patients with RA who were prescribed etanercept in or before September 1999, who also had at least one year9s follow up in the same outpatient clinic, were surveyed. The primary outcome measure was the number of disease flares in one year before and after etanercept use. The secondary outcome measures included the number of patients who did and did not flare, how flares were treated, and the drug alterations that were necessary during the same two time intervals. <b>Results:</b> The total number of flares for all patients in the year before etanercept treatment was 214 (mean (SD) 2.43 (1.75)). The number of flares in the first year of etanercept treatment decreased to 83 (mean 0.94 (1.07)) (p&lt;0.0001). The total number of patients who had at least one flare in the year before etanercept use was 80; eight had no flares. In their first year of etanercept treatment, 50 patients had at least one flare; 38 had no flares (p&lt;0.0001). Twenty one patients (24%) stopped using etanercept before completing one year9s treatment. <b>Conclusion:</b> This study of patients with RA in the "real world" shows that etanercept is effective in reducing the number of RA flares.
Nameless woe: medical themes in Richard II
Authors: T. Dalrymple
Journal: BMJ (2012)

More has been written about Shakespeare and the law than about Shakespeare and medicine, yet you could still fill a small library with the second group; and it is my contention that every play of his contains much to interest doctors. To test this hypothesis I took one play, Richard II , to scan it for medical interest.

I chose Richard II because I found an edition for £1 in a nearby charity shop, which I thought I could mark up without a sense of guilt at the defacement. Annotations to books are always ugly and disfiguring until they are 100 years old, when they become of historical interest. It is a curious transformation.

The medical …
That "Neurasthenia" Foolishness.
Authors: J. L. Tracy
Journal: JAMA (1904)

<h3>Toledo, O., March 30, 1904.</h3><h3>To the Editor:</h3> —Your editorial of March 26 under the title "The Tyranny of Words in Medicine," wherein you refer to the unscience of the word neurasthenia as at present used in medicine, is in harmony with an extreme tiredness which has grown on me from the use of that word. The word started high in the medical profession and so was entitled to respectful consideration, but I believe that it long since had its full mete of attention, and I believe too that now both the physician and the sick man are better off without it. I feel relieved and grateful to any one who gives even a plausible cause, like "eye strain," for the conglomeration of nervous symptoms and their functional manifestation which are now bunched together under that alleged nosologic entity. Within my time this varying jumble of symptoms has been said
Hyperostosis Frontalis Interna and Serum Enzymes in Obese Women
Authors: MAURICE VERDY
Journal: Annals of Internal Medicine (1974)

Letters1 September 1974Hyperostosis Frontalis Interna and Serum Enzymes in Obese WomenMAURICE VERDY, M.D., F.R.C.P.(C), F.A.C.P., PIERRE FAUTEUX, M.D., DANIEL CARONMAURICE VERDY, M.D., F.R.C.P.(C), F.A.C.P.Search for more papers by this author, PIERRE FAUTEUX, M.D.Search for more papers by this author, DANIEL CARONSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-81-3-409 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Hyperostosis frontalis interna has been reported to be related to obesity (1,2) and, more recently, to be associated with an increase in the concentration of serum alkaline phosphatase (3). Because this concentration is increased in obese subjects (4,5), we examined possible relations among obesity, alkaline phosphatase, and the bone disorder.The obese patient group was composed of 55 obese women, ages 20 to 49 years, who were hospitalized for total starvation; skull X rays were taken in 40. One hundred consecutive women, ages 20 to 50 years, requiring skull X rays in the Emergency Department served as...References1. MOREL F: L'hyperostose frontale interne. Syndrome de l'hyperostose frontale interne avec adipose et troubles cérébraux. Paris, Gaston, Doin et Cie, 1930 Google Scholar2. MOORE S: Hyperostosis Cranii. Springfield, Charles C Thomas, Publisher, 1955 Google Scholar3. GEGICKDANOWSKIKHURANA CTR: Hyperostosis frontalis interna and hyperphosphatasemia. Ann Intern Med 79: 71-75, 1973 LinkGoogle Scholar4. ZELMAN S: The liver in obesity. Arch Intern Med 90:141, 1952 CrossrefGoogle Scholar5. WESTWATERFAINER JD: Liver Impairment in the Obese. Gastroenterology 34:4, 686, 1958 CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Service d'Endocrinologie-Metabolisme et Nutrition Hôtel-Dieu Hospital Montreal, Canada PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByBenign Hyperostotic Mass of the Frontal BoneHyperostosis frontalis interna: What does it tell us about our health? 1 September 1974Volume 81, Issue 3Page: 409-411KeywordsAttentionBoneEmergency departmentEnzymesObesityOverweightPhosphatasesSkullStarvation Issue Published: 1 September 1974 PDF DownloadLoading ...