tbuckley/cabot-search huggingface dataset:
Early postoperative delirium after open-heart cardiac surgery is associated with decreased bispectral EEG and increased cortisol and interleukin-6
Authors: Konstanze Plaschke, Philipp Fichtenkamm, Christoph Schramm, Steffen Hauth, Eike Martin, Markus Verch, Matthias Karck, Jürgen Kopitz
Journal: Intensive Care Medicine (2010)
Training tomorrow's surgeons
Authors: V. C Y Tang, E. W Y Lee
Journal: Journal of the Royal Society of Medicine (2007)

By couching the discussion of Blair and Bush in terms of hubris and nemesis, Lord Owen 1 has avoided the pitfall of diagnosis from afar while still highlighting serious problems with the two world leaders (JRSM November 2006).He does dip his toe into psychodynamics citing Freud and Justin Frank, but, by and large, he sticks to discussing behaviour and its relation to hubris and power.As a politician, Lord Owen is qualified to discuss the political leaders he has encountered.As a physician, should he be making medical judgments on political leaders?Simon Wessely has questions about this and about whether or not psychiatrists should venture beyond the consulting room. 2 Should psychiatrists limit their judgments to patients they have examined?The American Psychiatric Association says 'yes' and Dr Wessely cites data to support that view.But the question remains, can psychiatrists and neuroscientists, with the help of philosophers, provide useful insights that contribute to the understanding of leaders and their followers?I believe that we should try.We should bring whatever scientific data there may be to counter ideology, blind faith and the intoxicating effects of power.It is true hubris often comes with power.Even though we do not have a psychiatric diagnosis for hubris, it is a psychological entity and as such should potentially be understood by science, as are other psychological phenomena.We do not diagnose those that we have not personally examined and we cannot diagnose an entire population, but perhaps we can bring clinical and scientific insights to help understand destructive behaviour As scientists and clinicians, we too must guard against hubris.Hopefully our colleagues will help us with that.JRMS should be applauded for exploring the issue.
A TEST PROCEDURE FOR THE EASY DIAGNOSIS OF EPIGASTRIC HERNIA
Authors: Horace F. W. Warden
Journal: JAMA (1927)

<h3>To the Editor:</h3> —Epigastric hernia is more common than the meager references to it would lead one to suppose. The reason is failure in diagnosis; for unless one is particularly on the lookout for it, one can easily miss it and attribute the symptoms to something totally different. Not every epigastric hernia will necessarily produce symptoms, but a small one may cause a wide variety simulating the condition set forth by Friedenwald and Morrison (The Journal, Oct. 30, 1926, p. 1466). During the last three years I have seen about a score of such cases. The diagnosis has been made in almost every case by a certain procedure of palpation and, if indicated, confirmed by laboratory and roentgen-ray tests, which, of course, were negative. A clue to the condition may often be obtained from the history, especially when the symptoms are associated with pain which has no relation to food
Anti-inflammatory effects of leflunomide on cultured synovial macrophages from patients with rheumatoid arthritis
Authors: M Cutolo, A Sulli, P Ghiorzo, C Pizzorni, C Craviotto, B Villaggio
Journal: Annals of the Rheumatic Diseases (2003)

Leflunomide and its active metabolite A77 1726 reversibly inhibits the enzyme dihydro-orotate dehydrogenase, the rate limiting step in de novo synthesis of pyrimidines and progression of the cell cycle in different cell lines, mainly activated T lymphocytes. To analyse in vitro the possible anti-inflammatory effects exerted by A77 1726, on cultured macrophages, obtained from the synovial tissues of patients with rheumatoid arthritis (RA). The effects of different doses of A77 1726 on intracytoplasmic expression and extracellular concentration of inflammatory cytokines (tumour necrosis factor alpha (TNFalpha), interleukin (IL) 1beta, IL6), as well as the influence on production and expression of intercellular adhesion molecule-1 (ICAM-1) and cyclo-oxygenase 2 (COX-2) by primary cultures of synovial macrophages from patients with RA, were evaluated by immunocytochemistry and western blot analysis. The observations were made at four and 24 hours. A progressive and significant time and dose dependent decrease of the number of positive macrophages for intracellular TNFalpha and IL1beta, treated with different doses of A77 1726, was found in comparison with untreated cells. The extracellular concentration of TNFalpha was found to be significantly decreased in media containing cultured macrophages at 24 hours for all tested doses of A77 1726. At 24 hours, a significant time and dose dependent decrease of ICAM-1 and COX-2 expression by cultured macrophages after A77 1726 treatment was found. In conclusion, the mechanism of antiproliferative activity exerted by leflunomide on activated T lymphocytes seems to be the same mechanism (alteration of the cell cycle progression) which interferes with the functions of other activated cells-namely, the monocytes/macrophages, which are strongly involved in the inflammatory reaction in RA synovial tissue. The positive clinical results seem to confirm that leflunomide exerts an anti-inflammatory action on phagocytic cells in short and long term treatment of RA.
Delayed maturation of an IL-12–producing dendritic cell subset explains the early Th2 bias in neonatal immunity
Authors: Hyun-Hee Lee, Christine M. Hoeman, John C. Hardaway, F. Betul Guloglu, Jason S. Ellis, Renu Jain, Rohit Divekar, Danielle M. Tartar, Cara L. Haymaker, Habib Zaghouani
Journal: The Journal of Experimental Medicine (2008)

Primary neonatal T cell responses comprise both T helper (Th) cell subsets, but Th1 cells express high levels of interleukin 13 receptor α1 (IL-13Rα1), which heterodimerizes with IL-4Rα. During secondary antigen challenge, Th2-produced IL-4 triggers the apoptosis of Th1 cells via IL-4Rα/IL-13Rα1, thus explaining the Th2 bias in neonates. We show that neonates acquire the ability to overcome the Th2 bias and generate Th1 responses starting 6 d after birth. This transition was caused by the developmental maturation of CD8α+CD4− dendritic cells (DCs), which were minimal in number during the first few days of birth and produced low levels of IL-12. This lack of IL-12 sustained the expression of IL-13Rα1 on Th1 cells. By day 6 after birth, however, a significant number of CD8α+CD4− DCs accumulated in the spleen and produced IL-12, which triggered the down-regulation of IL-13Rα1 expression on Th1 cells, thus protecting them against IL-4–driven apoptosis.
Single-Dose Phenytoin Infusion
Authors: Denson G. Fujikawa
Journal: Annals of Internal Medicine (1990)

Letters and Corrections1 February 1990Single-Dose Phenytoin InfusionDenson G. Fujikawa, MDDenson G. Fujikawa, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-3-235_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor:As a neurologist who treats patients with status epilepticus, I disagree strongly with the suggestion by Blaser and colleagues (1) that their loading regimen for intravenous phenytoin, even when combined with intravenous diazepam, should be used to treat those with this condition. Status epilepticus can cause brain damage (2) and permanent memory impairment (3) in humans. Irreversible brain damage has been documented after a seizure period as short as 90 minutes in the baboon (4). In some instances seizures will continue even after phenytoin and diazepam have been given, and other anticonvulsants or even general anesthesia may...References1. Blaser K, Vozeh S, Landolt H, Kaufmann G, Romppainen J, and Gratzl O. Intravenous phenytoin: a loading scheme for desired concentrations. Ann Intern Med. 1989;110:1029-31. LinkGoogle Scholar2. Soffer D, Melamed E, Assaf Y, and Cotev S. Hemispheric brain damage in unilateral status epilepticus. Ann Neurol. 1986;20:737-40. CrossrefMedlineGoogle Scholar3. Treiman D and Delgado-Escueta A. Complex partial status epilepticus. In: Delgado-Escueta AV, Wasterlain CG, Treiman DM, Porter RJ, eds. Status Epilepticus: Mechanisms of Brain Damage and Treatment. Advances in Neurology. v 34. New York: Raven Press; 1983:69-81. Google Scholar4. Meldrum B and Brierley J. Prolonged epileptic seizures in primates: ischemic cell change and its relation to ictal physiological events. Arch Neurol. 1973;28:10-7. CrossrefMedlineGoogle Scholar5. Crawford R, Leppik I, Patrick B, Anderson C, and Kostick B. Intravenous phenytoin: Clinical and pharmacokinetic aspects. Neurology. 1978;28:874-80. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Denson G. Fujikawa, MDAffiliations: Veterans Affairs Medical Center Sepulveda, CA 91343 UCLA School of Medicine Los Angeles, CA 90024 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 February 1990Volume 112, Issue 3Page: 235-236KeywordsAnticonvulsantsBrain damageDiazepamEpileptic seizuresGeneral anesthesiaMemoryStatus epilepticus ePublished: 1 December 2008 Issue Published: 1 February 1990 PDF downloadLoading ...
Direct Arterial Blood Pressure Measurements-Reply
Authors: Elemer K. Zsigmond
Journal: JAMA (1981)

<h3>In Reply.—</h3> I well recognize the advantages of the direct arterial BP measurements, since I was among the first who routinely used it in clinical anesthesia and intensive care. In combination with ECG and phonocardiography, I have used the arterial tracings in the calculation of systolic time intervals (PEP/LVET).<sup>1</sup>Furthermore, I agree with Dr Goyette on the relative safety of arterial catheterization, since I have experienced only two transient arterial spasms, but no permanent sequelae, in more than 5,000 patients with radial artery catheterization and 300 sophisticated health professional volunteers with brachial arterial catheterization. I hope to summarize my experience with arterial catheterization gained in the past 20 years in a review article soon.
Acetazolamide Prophylaxis in Hypokalemic Periodic Paralysis
Authors: Jerome S. Resnick, W. King Engel, Robert C. Griggs, Alan C. Stam
Journal: New England Journal of Medicine (1968)

When acetazolamide, an agent used to treat hyperkalemic periodic paralysis, was inadvertently found to relieve a patient with the hypokalemic variety, he and another patient were observed to compare this agent with conventional therapy. Well tolerated doses of acetazolamide, 375 to 500 mg daily, eliminated severe attacks and were much more effective than potassium or spironolactone. Preliminary results in five additional patients with hypokalemic periodic paralysis indicated that only three are improved. Two have not benefited. It seems paradoxical that acetazolamide is prophylactic for both hypokalemic and hyperkalemic periodic paralysis. The mechanism of its action in the hypokalemic variety is not known. It did not appear to affect serum potassium, total body potassium, total body sodium, blood pH, nor was the agent shown to affect muscle excitability directly.
Systemic responsiveness to lipopolysaccharide and polymorphisms in the toll-like receptor 4 gene in human beings
Authors: Olivier Michel, Tricia D LeVan, Debbie Stern, Mieke Dentener, Jörgen Thorn, Daniele Gnat, M.Lena Beijer, Pascale Cochaux, Patrick G Holt, Fernando D Martinez, Ragnar Rylander
Journal: Journal of Allergy and Clinical Immunology (2003)
Screening for familial intracranial aneurysms
Authors: P. J Kirkpatrick, R S McConnell
Journal: BMJ (1999)

Familial intracranial aneurysms are those which have been identified in two or more first degree relatives. The relative risk for intracranial aneurysms in such families is about four times that of the general population. 1 2 In the general population the prevalence has been estimated from a meta-analysis to average 2.3% (95% confidence interval 1.7 to 3.1), though the meta-analysis also pointed out the wide variation in prevalence according to method of diagnosis and selection processes.3 In view of the high mortality and morbidity associated with ruptured intracranial aneurysms, screening for unruptured intracranial aneurysms has been suggested, is practised by many, and would at first sight seem a worthwhile goal. Once an aneurysm is discovered, options include treatment or further surveillance to detect growth The recent improved sensitivity of non-invasive magnetic resonance angiography has made screening more practicable. So should we now be seriously considering screening people for familial aneurysms?

People with familial intracranial aneurysms represent about 5-10% of all patients presenting with an aneurysmal subarachnoid haemorrhage.4 Both genetic and environmental factors have been implicated to explain the clustering of intracranial aneurysms in families. These cases usually bleed at an earlier age and form smaller intracranial aneurysms than those of the general population of people with a subarachnoid haemorrhage, indicating enhanced susceptibility of the vascular wall, whether genetically determined …
Effect of Hypoadrenalism and Excessive Doses of Desoxycorticosterone Acetate upon Response of the Rat to Ouabain
Authors: DAVID UNTERMAN, ARTHUR C. DEGRAFF, HERBERT S. KUPPERMAN
Journal: Circulation Research (1955)

The influence of alterations of adrenal function upon the responsiveness of the rat to intravenously administered ouabain was studied electrocardiographically by the string galvanometer. Conduction disturbances followed by cardiac arrest were the criteria for a definitive response. Adrenalectomized rats showed a significant increase in sensitivity to ouabain as compared with normal controls. Normal animals implanted with pellets of desoxycorticosterone acetate and continuously maintained on saline drinking water did not show a significant alteration in their responsiveness to ouabain.
Isolation and characterization of a heat‐resistant beef allergen: myoglobin
Authors: Mª. M. Fuentes, R. Palacios, Mª. M. Garcés, M. L. Caballero, I. Moneo
Journal: Allergy (2004)

Background: Meat allergy is rarely reported. Most of the described cases are sensitizations to bovine serum albumin. Objective: The aim of the study was to describe a case of allergy to a new meat allergen and, after its characterization. Methods: A 35‐year‐old nonatopic female with allergic episodes after ingestion of several types of meat was studied. Skin tests (prick and prick‐to‐prick); total and specific immunoglobulin E (IgE) determination; sodium dodecyl sulphate‐polyacrylamide gel electrophoresis and specific IgE determination by immunoblotting under different conditions were performed. A 17‐kDa allergen was semipurified by ethanol fractionation and its amino‐terminal sequence was determined. The existence of specific IgE directed to this protein was studied by immunoblot in 80 atopic patients. Results: The patient showed specific IgE antibodies to a 17‐kDa protein. During the isolation of this allergen it was found that a 70–90% (vol/vol) ethanol concentration was able to purify the protein. The characterization revealed that it was a heat‐resistant protein without disulfide bonds. N‐terminal amino acid sequence (16 residues) showed identity with myoglobin. The study of specific IgE to this allergen among atopic patients showed that it was recognized by about 1% of the subjects. Conclusions: We describe a case of meat allergy caused by myoglobin. This is the first described case of monosensitization to this protein.
Vascular Birthmarks: Hemangiomas and Malformations
Authors: Richard Carlton Schultz
Journal: JAMA (1989)

Vascular birthmarks have been an enigma from the beginning of recorded medical history. Since antiquity these lesions have been well described in various colors, locations, textures, and elevations, but their causes and classifications have remained speculative and confusing if not unscientific. They are more common than generally realized (one in every three children, according to these authors), although gross and disfiguring lesions are thankfully rare. Unfortunately, however, the advice on management and treatment given to those patients seeking medical opinions is generally disappointing. It is to the primary physician who needs to have both knowledge and perspective to be able to steer these bewildered patients through the many existing therapeutic pitfalls that this text is directed. <i>Vascular Birthmarks</i>is a classic medical monograph. It discusses this single entity rather thoroughly, dealing first with a delightful chapter on its history, folklore, and literature. As evidence of its timelessness the authors have
Dangers of corn starch powder.
Authors: S V Humphries
Journal: BMJ (1973)

Sick Sinus Syndrome Sn,-T7here are two points in your leading article on sinuatrial disorder (23 June, p. 677) whikh require comment.The familial nature of this disorder requires stressing since it is not only in the younger relatives that it can be asymptonatic.Moreover, not all affected patents fai to develop a tachy- cardia on exercise, and older and affected siblings may neglect their sytoms until cerebral or cardiac catastophes occur.Earlier diagnosis by careful screening of the families of affected patients using simple clinical nethodsj can prevent unnecessary cardiac and cerebrl neurosis and allow planned follow-up of the asymptonatic but affected patients and then earlier provision of effec tive treatment when sym ms do occur.Although angina caused by persisenice of bradycardia during exercise and rest has been described as an aetiological factor for the anginal syoms and cerebra distubances of John Hunter,2 your leading article surely misplaced one reference source.'This com- muncation, the first to use the term sinuatrial disorder in 1971, suggested that acute hyperextension of the neck causing indirect trauma to the sinuatrial node may be a more common contributory cause of death in patients with closed head injury than is at present recognized.-Iam, etc., B. LIvEsLEY
The Role of Community Consultation in the Ethical Conduct of Research Without Consent
Authors: Lynne D. Richardson, Rosamond Rhodes, Deborah Fish Ragin, Ilene Wilets
Journal: The American Journal of Bioethics (2006)

In 1996, the federal government finalized regulations that permit certain types of emergency research without obtaining prospective informed consent from participants or their surrogates (U.S. Food...
A5.25 Proteomic Analysis of Anti-CCP Immunoglobulins for the Identification of Rheumatoid Arthritis Patients that Require early Aggressive Treatment Regimens
Authors: Martijn M van Duijn, Theo M Luider, Johanna MW Hazes, Radboud JEM Dolhain
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background and Objectives</h3> Antibodies against citrullinated peptides (ACPA) are a hallmark of rheumatoid arthritis (RA) patients and are associated with poor outcome. ACPA are usually detected using the anti-CCP test, identifying antibodies against a broad spectrum of citrullinated antigens. Most citrullinated antigens however appear to be bystander antigens that are not thought to be involved in the disease process. While controversy remains over the identity of the pathogenic antigen, it has been hypothesised that the fine-specificity of the ACPA response in the patient harbours prognostic properties. For this purpose sera will be studied from early RA patients using a novel technique that might reveal differences in that fine-specificity of the ACPA response. <h3>Materials and Methods</h3> We recently showed that the antibody response to a particular antigen results in rearranged immunoglobulin segments that are shared between individuals exposed to that antigen. In patients with paraneoplastic neurological syndromes, such sequences were found after proteomics analysis of affinity enriched immunoglobulins. In the current study, ACPA positive RA sera were drawn from 58 patients participating in the tREACH-study. This is a study with a protocolised treatment regime for patients with early RA aimed at obtaining low-disease activity (DAS &lt; 2.4). Poor outcome was defined as the need for treatment with anti-TNF to control disease activity. Sera were affinity enriched using CCP2 ELISA plates, and the specific IgG was analysed by LC-MS. <h3>Results</h3> Up to 1 µg of CCP specific IgG was obtained from 180 µl of serum. The LC-MS data was analysed for correlations between ACPA derived peptides and the need for treatment with anti-TNF to control disease activity. However, no such correlations were found in excess of the false discovery rate in this dataset. In addition to ACPA, we also affinity purified rheumatoid factors from sera as a control. These preparations could be distinguished from the ACPA, suggesting our method performed appropriately. <h3>Conclusions</h3> Our experiments could not show a significant difference between anti-CCP antibodies in early RA sera from patients with different disease outcome. While this could indicate that anti-CCP fine-specificities are not associated with disease outcome, additional experiments are needed to interpret these results. In future work we will compare IgG with known affinity to subclasses of CCP antigens to verify that our technique distinguishes these more subtle differences in epitope specificity. In addition, it will be investigated whether fine specificity may affect the progression to arthritis in ACPA+ arthralgia patients.
Therapy of Cystinosis
Authors: Jerry A. Schneider
Journal: New England Journal of Medicine (1985)

Cystinosis is a recessively inherited disorder characterized by an accumulation of free cystine within lysosomes. The lysosome is a major site of intracellular protein degradation, which results in the release of free amino acids that must pass through the lysosomal membrane to the cytosol. Lysosomal cystine efflux requires a specific transport system that is defective in cystinosis. This defect has been demonstrated in lysosomes from peripheral-blood leukocytes, cultured skin fibroblasts, and Epstein–Barr virus—transformed lymphoblasts from patients with this disorder, and has been verified in three separate laboratories.1 2 3 4 5 Patients with infantile nephropathic cystinosis present for medical attention at 8 to 15 . . .
The Unlockjaw Syndrome
Authors: G. G. Liddle
Journal: JAMA (1974)

To the Editor.—  Into my office a week ago barged seven bearded, sweat-drenched halftails, with a patient in tow. Pushing me to the side, they lashed him to the examining table and rushed away on their bumblebee cycles as fast as the machines would accelerate. A worm-eaten $10 bill was pinned to the patient's chest.  Report of a Case.—  The patient was a male, perhaps 25-year-old, disheveled specimen, alive, emitting a strange nonfetid, but disgusting, aromatic vapor. His jaws moved constantly, never quite closing, in a revolting figure-of-eight, saccadic rhythm, faster west-to-east than north-to-south. His eyes blinked constantly, his speech was unintelligibly confused by the drool exuding from his mouth. Reflexes were violently active. Omitting obviously irrelevant data on blood pressure, fever, and MMPI testing, I rapped him over the shins, gouged him in the eyeballs, and hyperextended his finger joints until he quieted sufficiently to obtain a specimen of