tbuckley/cabot-search huggingface dataset:
The WHO: change or die
Authors: R. Smith
Journal: BMJ (1995)

The WHO: change or die Reforn must begin now but will depend on a new le We need a worldwide body for health.Many health problems cannot be tackled by individual countries alone.Some problems-like infectious diseases, drug misuse, and the health consequences of climatic change-pay no attention to national boundaries.Disasters like those that have happened in Rwanda and Bosnia need a response that cannot be mounted by single countries.Many poor countries must tackle immense health problems with hopelessly limited resources, and they need good technical help and advice.And all countries, including rich ones, need international leadership on health that sets standards.Perhaps, for instance, an effective world body for health could help the United States respond to its dreadful health problems, which give many ofits citizens Third World health standards.Unfortunately, we don't have an effective, efficient, responsive, well managed body to provide the world with leadership on health.What we have is the World Health Organisation, which-despite some spectacular successes in the past and some continuing successes now-is in poor shape.As Fiona Godlee has illustrated in her series that ends today (p 583), the WHO lacks effective leadership and is unclear about its mandate, direction, and priorities.In addition, it is overcentralised at headquarters and regions, top heavy, poorly managed, and bureaucratic and smells of
Children, Stigma, and Obesity
Authors: Daniel Callahan
Journal: JAMA Pediatrics (2013)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Pediatrics journal
T-Wave Abnormalities of Intermittent Left Bundle-Branch Block
Authors: TOBY R. ENGEL
Journal: Annals of Internal Medicine (1978)

Ischemia is traditionally considered a cause of intermittent left bundle-branch block (LBBB), and some patients have right precordial T-wave inversion in the normally conducted beats. Clinical correlates of T-wave abnormalities were examined in 46 consecutive patients with intermittent LBBB. Thirty-three patients (72%) had at least transient right precordial (V-14) T-wave inversion suggesting ischemia in normally conducted beats. Seventeen such patients had no evidence of coronary heart disease, including five with normal arteriograms. During LBBB conduction, T-wave abnormalities (upright T-waves I, aVL, V5-6) were frequent (48%) and more common than among patients with permanent LBBB (p less than 0.005). The T-wave abnormalities during LBBB conduction occurred in the absence of coronary heart disease in nine patients, including two with normal arteriograms. Thus, right precordial T-wave inversion may result from recent LBBB itself, associated with T-wave abnormalities during the LBBB, in the absence of coronary artery disease.
THE COMPARISON OF STROKE VOLUME BY CINE MRI AND PHASE CONTRAST VELOCITY MAPPING
Authors: Takashi Tanimoto, Yuichi Ozaki, Kohei Ishibashi, Takashi Yamano, Yasushi Ino, Tomoyuki Yamaguchi, Kumiko Hirata, Toshio Imanishi, Takashi Akasaka
Journal: Journal of the American College of Cardiology (2013)
FDG PET/CT Findings in 3 Cases of Pulmonary Peripheral T-Cell Lymphoma
Authors: Aisheng Dong, Changjing Zuo, Yang Wang, Yong Cui
Journal: Clinical Nuclear Medicine (2013)

Pulmonary involvement of peripheral T-cell lymphoma is rare. It is difficult to make a clinical and radiologic diagnosis of pulmonary lymphomatous involvement, yet the diagnosis is often critical in determining treatment. We present 3 cases of pulmonary peripheral T-cell lymphoma with FDG PET/CT findings. In these 3 cases, FDG PET/CT images revealed multiple bilateral FDG-avid nodules, masses, or mass-like consolidations with or without air bronchogram. Familiarity with these imaging features may be helpful for the diagnosis and differential diagnosis.
Evidence Concerning the Effect of Insulin On Carbohydrate Tolerance
Authors: WM. M. LEFEVRE
Journal: Annals of Internal Medicine (1928)

Article1 February 1928Evidence Concerning the Effect of Insulin On Carbohydrate ToleranceWM. M. LEFEVRE, A.B., M.D.WM. M. LEFEVRE, A.B., M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-1-8-607 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPrevious to the discovery of insulin the treatment of diabetes mellitus consisted entirely of dietary measures. Various writers outlined methods of procedure which were calculated to maintain a sugar free urine and still keep the patient fairly well nourished. These experiments met with a variable degree of success, depending on the severity of the disease in the patients under their care.The discovery of insulin changed the treatment of this malady as no treatment has been changed before. The early writings on insulin which appeared shortly after the completion of the experimental work which led to its discovery, give one...Bibliography(1) BANTING FG et al.; Canadian Medical Association Journal 12: 141, March, 1922. MedlineGoogle Scholar(2) BRACE WM, Insulin and Carbohydrate Tolerance. Annals of Internal Medicine, Volume 1, No. 4-203. October, 1927. Google Scholar(3) PETTY OH, The Practical Use of Insulin in the Treatment of Diabetes. International Clinics Volume 2, Series 33, pp. 37. Google Scholar(4) WOODYATT RT, Objects and Methods of Diet and Adjustment to Diabetes. Archives Internal Medicine 28: 125, 1921. CrossrefGoogle Scholar(5) NEWBURGH LH, High Fat Diet in the Treatment of Diabetes Mellitus. Medical Clinics North America. 6:1119, March, 1923. Google Scholar(6) MCCALLUM WG, Hypertrophy of Islands of Langerhans in Diabetes Mellitus. J. A. M. Sc. 133-432. Google Scholar(7) WILLIAMS JR, Result of Long Continued Use of Insulin in Diabetes. New York State Journal of Medicine 27:49 Jan. 15, 1927. Google Scholar(8) JOHN HJ, Diabetes—One Thousand Cases. Archives Internal Medicine 39:1-162, January, 1927. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: WM. M. LEFEVRE, A.B., M.D.Affiliations: Muskegon, Michigan PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 February 1928Volume 1, Issue 8Page: 607-612KeywordsCarbohydratesDiabetes mellitusInsulinPatientsUrine ePublished: 1 December 2008 Issue Published: 1 February 1928 PDF downloadLoading ...
Insulin and the Polycystic Ovary Syndrome
Authors: Robert D. Utiger
Journal: New England Journal of Medicine (1996)

The cardinal clinical manifestations of the polycystic ovary syndrome are hirsutism and anovulation, oligomenorrhea, or amenorrhea. About half the women with this syndrome are obese, and some have diabetes mellitus. Underlying these clinical abnormalities is an array of biochemical abnormalities that have defied simple explanation. Among them, the most important are increased serum concentrations of total and free testosterone, decreased serum sex hormone–binding globulin concentrations, increased serum luteinizing hormone concentrations, and hyperinsulinemia. Not all affected women have all these biochemical abnormalities, but in the aggregate, these findings, along with the clinical abnormalities, are characteristic of the syndrome.1 Anatomically, most of . . .
Rising emergency admissions
Authors: R. Hobbs
Journal: BMJ (1995)

The National Association of Health Authorities and Trusts reports that providers of secondary care are under pressure from ever rising numbers of acute medical admissions, which were up between 7% and 13% from average rates during 1993–4.1 This is not a recent concern: the Audit Commission, extrapolating from routinely collected hospital data, predicted a doubling of acute admissions to Birmingham hospitals between 1987 and 1996.2

The National Association of Health Authorities and Trusts suggests that the probable causes of the increase include more detected illness, raised expectations of general practitioners (especially fundholders), premature discharge, and worries over litigation. Others point accusingly to variations in general practitioners' referral rates; Acheson was irritated in 1985 that “a phenomenon so gross can continue to defy analysis.”3 Fundholders are accused of protecting budgets, although they generally do not have to pay for emergency care.

Unfortunately, evidence to illuminate this issue is scarce. Although a substantial body of research exists on total referrals to hospital, remarkably few data exist …
Simultaneous Targeting of IL-1 and IL-18 Is Required for Protection against Inflammatory and Septic Shock
Authors: Tom Vanden Berghe, Dieter Demon, Pieter Bogaert, Benjamin Vandendriessche, Alain Goethals, Bart Depuydt, Marnik Vuylsteke, Ria Roelandt, Elien Van Wonterghem, Jill Vandenbroecke, Sze Men Choi, Evelyn Meyer, Stefan Krautwald, Wim Declercq, Nozomi Takahashi, Anje Cauwels, Peter Vandenabeele
Journal: American Journal of Respiratory and Critical Care Medicine (2014)

Rationale: Sepsis is one of the leading causes of death around the world. The failure of clinical trials to treat sepsis demonstrates that the molecular mechanisms are multiple and are still insufficiently understood.Objectives: To clarify the long disputed hierarchical contribution of several central inflammatory mediators (IL-1β, IL-18, caspase [CASP] 7, CASP1, and CASP11) in septic shock and to explore their therapeutic potential.Methods: LPS- and tumor necrosis factor (TNF)-induced lethal shock, and cecal ligation and puncture (CLP) were performed in genetically or pharmacologically targeted mice. Body temperature and survival were monitored closely, and plasma was analyzed for several markers of cellular disintegration and inflammation.Measurements and Main Results: Interestingly, deficiency of both IL-1β and IL-18 additively prevented LPS-induced mortality. The detrimental role of IL-1β and IL-18 was confirmed in mice subjected to a lethal dose of TNF, or to a lethal CLP procedure. Although their upstream activator, CASP1, and its amplifier, CASP11, are considered potential therapeutic targets because of their crucial involvement in endotoxin-induced toxicity, CASP11- or CASP1/11-deficient mice were not, or hardly, protected against a lethal TNF or CLP challenge. In line with our results obtained in genetically deficient mice, only the combined neutralization of IL-1 and IL-18, using the IL-1 receptor antagonist anakinra and anti–IL-18 antibodies, conferred complete protection against endotoxin-induced lethality.Conclusions: Our data point toward the therapeutic potential of neutralizing IL-1 and IL-18 simultaneously in sepsis, rather than inhibiting the upstream inflammatory caspases.
Risk of Initiating Antiarrhythmic Drug Therapy for Atrial Fibrillation in Patients Admitted to a University Hospital
Authors: William H. Maisel
Journal: Annals of Internal Medicine (1997)

The risks of antiarrhythmic therapy are increasingly recognized, but the risks associated with the initiation of antiarrhythmic therapy in patients hospitalized for atrial fibrillation are poorly defined.To determine the incidence, time course, and predictors of adverse cardiac events that require intervention during initiation of antiarrhythmic drug therapy for atrial fibrillation.Retrospective chart review.University hospital.417 consecutive patients who underwent a total of 597 drug trials during a total of 550 hospitalizations for atrial fibrillation.Initiation of therapy with antiarrhythmic drugs: procainamide (189 trials), quinidine (179 trials), disopyramide (20 trials), propafenone (110 trials), flecainide (2 trials), sotalol (72 trials), and amiodarone (25 trials). Electrical conversion was performed during 247 trials.Incidence of adverse events and daily hazard rate were measured. Logistic regression was done to identify risk factors.During the 597 drug trials, 80 (13.4%) cardiac adverse events occurred in 73 patients. The risk was greatest during the first 24 hours of therapy. Bradyarrhythmias were the most common adverse event, occurring in 47 trials (7.9%); prolongation of the QT interval warranting discontinuation of drug therapy (9 trials; 1.5%) and ventricular arrhythmias (8 trials; 1.3%) were less frequent. In multivariate analysis, previous myocardial infarction was associated with increased risk (odds ratio, 1.90 [95% CI, 1.05 to 3.43]) and the association between older age and increased risk (odds ratio, 1.29 per decade [CI, 0.97 to 1.72]) was of borderline statistical significance.A significant risk for cardiac adverse events exists during initiation of antiarrhythmic therapy in patients hospitalized for atrial fibrillation. Observation with electrocardiographic monitoring seems advisable for 24 to 48 hours during initiation of antiarrhythmic therapy, particularly for elderly patients and patients who have previously had myocardial infarction.
The place of walk-in clinics in healthcare systems
Authors: B. Hutchison
Journal: BMJ (2000)

Papers p 928 

Walk-in clinics have existed in Canada since the late 1970s, but the evidence on who uses them and why, and their effectiveness and economic impact, is disconcertingly sparse. Of the nine primary studies cited in a review of walk-in clinics in Canada, published in this issue of the BMJ (p 928), six were surveys of patients attending walk-in clinics, emergency departments, or general practices; one was a review of the clinical records of patients attending an after hours clinic; one surveyed staff informants at walk-in clinics about organisational arrangements and services; and one compared the costs of treatment at walk-in clinics, general practices, and emergency departments using data on fee for service claims from a provincial health insurance plan.1 All but two studies were based on a single walk-in or after hours clinic or on samples of patients drawn from one or a small number of general practices. Most studies provided data from the early 1990s …
Photo hen's egg test: a model for phototoxicity
Authors: N.J. NEUMANN, E. HÖZLE, P. LEHMANN, M. ROSENBRUCH, A. KLAUCIC, G. PLEWIG
Journal: British Journal of Dermatology (1997)

The aim of this investigation was to establish a new model for phototoxicity which is more advanced than the widely used cultures of yeasts, bacteria or cells of various origin, and at the same time to avoid animal testing. We studied the extraembryonal vasculature of the incubated hen's egg. This model was originally introduced by toxicologists as an alternative to the rabbit's eye irritation test (Draize test). In the photo hen's egg test, substances are applied to the embryo's yolk‐sac blood vessel system at a non‐toxic concentration and are irradiated with 5 J/cm2 ultraviolet A (UVA) (320‐400 nm). Promethazine, haematoporphyrin, ciprofloxacin and 8‐methoxypsoralen were tested in this system. Death of the embryo, membrane discoloration and haemorrhage are parameters for phototoxic damage, which were recorded during an observation period of 24 h. These well‐known phototoxic substances induced pronounced damage of the yolk‐sac membrane and blood vessels which was not found in the controls (test substance alone, UVA alone or untreated) using a 2 × 2 factorial test design. The photo hen's egg test serves as a valid screening model for substances supposed to be photosensitizers owing to a phototoxic mechanism.
Resource Utilization in Liver Transplantation&lt;SUBTITLE&gt;Effects of Patient Characteristics and Clinical Practice&lt;/SUBTITLE&gt;
Authors: Jonathan Showstack, Patricia P. Katz, John R. Lake, Robert S. Brown, R. Adams Dudley, Steven Belle, Russell H. Wiesner, Rowen K. Zetterman, James Everhart
Journal: JAMA (1999)

Liver transplantation is among the most costly of medical services, yet few studies have addressed the relationship between the resources utilized for this procedure and specific patient characteristics and clinical practices.To assess the association of pretransplant patient characteristics and clinical practices with hospital resource utilization.Prospective cohort of patients who received liver transplants between January 1991 and July 1994.University of California, San Francisco; Mayo Clinic, Rochester, Minn; and the University of Nebraska, Omaha.Seven hundred eleven patients who received single-organ liver transplants, were at least 16 years old, and had nonfulminant liver disease.Standardized resource utilization derived from a database created by matching all services to a single price list.Higher adjusted resource utilization was associated with donor age of 60 years or older (28% [$53813] greater mean resource utilization; P=.005); recipient age of 60 years or older (17% [$32795]; P=.01); alcoholic liver disease (26% [$49596]; P=.002); Child-Pugh class C (41% [$67 658]; P<.001); care from the intensive care unit at time of transplant (42% [$77833]; P<.001); death in the hospital (35% [$67 076]; P<.001); and having multiple liver transplants during the index hospitalization (154% increase [$474 740 vs $186 726 for 1 transplant]; P<.001). Adjusted length of stay and resource utilization also differed significantly among transplant centers.Clinical, economic, and ethical dilemmas in liver transplantation are highlighted by these findings. Recipients who were older, had alcoholic liver disease, or were severely ill were the most expensive to treat; this suggests that organ allocation criteria may affect transplant costs. Clinical practices and resource utilization varied considerably among transplant centers; methods to reduce variation in practice patterns, such as clinical guidelines, might lower costs while maintaining quality of care.
MHC class II sequences of susceptibility and protection in Mexicans with autoimmune hepatitis
Authors: Miriam Nohemí Vázquez-García, Carmen Aláez, Angélica Olivo, Héctor Debaz, Elva Pérez-Luque, Ana Burguete, Silvia Cano, Gabriela de la Rosa, Norma Bautista, Arturo Hernández, José Bandera, Luis Fernando Torres, David Kershenobich, Fernando Alvarez, Clara Gorodezky
Journal: Journal of Hepatology (1998)
Diagnostic difficulties with a lipaemic blood sample
Authors: A. M S Brooks, R. B Paisey, M. J Waterson, J. C Smith
Journal: BMJ (2010)

A 38 year old woman with type 2 diabetes controlled by her diet was referred for emergency assessment in hospital by her general practitioner after complaining of epigastric pain radiating to her back. 

The patient was tachycardic and had epigastric tenderness on examination. A diagnosis of acute pancreatitis was suspected, but the patient’s serum amylase concentration was normal at 52 U/l (normal range 28-100 U/l) so alternative diagnoses were considered. The blood sample was noted to be lipaemic and a lipid profile was requested: serum cholesterol level was 27.9 mmol/l (1078.9 mg/dl) and serum triglyceride concentration was found to be greater than 100 mmol/l (8900 mg/dl). Chest radiograph did not show any gas under the diaphragm. 

The patient was prescribed simvastatin 40 mg once a day and commenced on an insulin infusion to decrease her serum triglyceride levels. She was also treated with intravenous fluids, but her abdominal pain worsened during the first 24 hours of hospital admission despite analgesia.



### 1) What is the suspected diagnosis and what is the likely cause?

#### Short answer

The suspected diagnosis is acute pancreatitis secondary to hypertriglyceridaemia.

#### Long answer

Acute pancreatitis is a potentially life threatening condition with an incidence of 100 …
Cutting into the sonolucent zone after coronary atherectomy: Correlation between intravascular ultrasound images and histological findings
Authors: Atsushi Takagi, Tetsuya Sumiyoshi, Masao Kawaguchi, Syunnsuke Tanino, Nobuhisa Magosaki, Kenji Nakamura, Saichi Hosoda
Journal: Journal of the American College of Cardiology (1996)
TCT-182 Angioplasty of the hand arteries in critical hand ischaemia
Authors: Zoltán Ruzsa, Zoltán Ruzsa, Karoly Toth, Zoltán Jambrik, Nandor Kovacs, György Szabó, Levente Molnar, Kálmán Hüttl, Béla Merkely
Journal: Journal of the American College of Cardiology (2012)
Small Molecule Kinase Inhibitor Screen Identifies Polo-Like Kinase 1 as a Target for Neuroblastoma Tumor-Initiating Cells
Authors: Natalie Grinshtein, Alessandro Datti, Mayumi Fujitani, David Uehling, Michael Prakesch, Methvin Isaac, Meredith S. Irwin, Jeffrey L. Wrana, Rima Al-awar, David R. Kaplan
Journal: Cancer Research (2011)

Neuroblastoma (NB) is an often fatal pediatric tumor of neural crest origin. We previously isolated NB tumor-initiating cells (NB TIC) from bone marrow metastases that resemble cancer stem cells and form metastatic NB in immunodeficient animals with as few as ten cells. To identify signaling pathways important for the survival and self-renewal of NB TICs and potential therapeutic targets, we screened a small molecule library of 143 protein kinase inhibitors, including 33 in clinical trials. Cytostatic or cytotoxic drugs were identified that targeted PI3K (phosphoinositide 3-kinase)/Akt, PKC (protein kinase C), Aurora, ErbB2, Trk, and Polo-like kinase 1 (PLK1). Treatment with PLK1 siRNA or low nanomolar concentrations of BI 2536 or BI 6727, PLK1 inhibitors in clinical trials for adult malignancies, were cytotoxic to TICs whereas only micromolar concentrations of the inhibitors were cytotoxic for normal pediatric neural stem cells. Furthermore, BI 2536 significantly inhibited TIC tumor growth in a therapeutic xenograft model, both as a single agent and in combination with irinotecan, an active agent for relapsed NB. Our findings identify candidate kinases that regulate TIC growth and survival and suggest that PLK1 inhibitors are an attractive candidate therapy for metastatic NB.